Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 019714 | NY |
NPI | 1225634470 |
---|---|
Provider Name | Mrs. Lisa Marie Olsen |
First Address | Kingston, NY 12401-5151 |
Second Address | Kingston, NY 12401-5151 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2020 |
Last Update Date | 11/12/2020 |