Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT0008786 | FL |
N | 225XP0200X | Occupational Therapist - Pediatrics | OT0008786 | FL |
NPI | 1063809994 |
---|---|
Provider Name | Ms. Lisa Revell-Brewer |
First Address | Tallahassee, FL 32317-9662 |
Second Address | Tallahassee, FL 32317-9662 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2015 |
Last Update Date | 17/04/2015 |