Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OC001979 | PA |
N | 225XH1200X | Occupational Therapist - Hand | 001979L | PA |
NPI | 1104116474 |
---|---|
Provider Name | Mrs. Lise Ann Rice |
First Address | Dalton, PA 18414-9065 |
Second Address | Dalton, PA 18414-9065 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2011 |
Last Update Date | 07/04/2011 |