Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 011702 | NY |
NPI | 1003123480 |
---|---|
Provider Name | Mrs. Lisa Marie Searles |
First Address | Syracuse, NY 13219 |
Second Address | Syracuse, NY 13219 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2010 |
Last Update Date | 20/11/2018 |