Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 2000146387 | MO |
NPI | 1023206703 |
---|---|
Provider Name | Ms. Lisa Diane England |
First Address | Tarkio, MO 64491-1138 |
Second Address | Tarkio, MO 64491-1138 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2007 |
Last Update Date | 09/10/2007 |