Individual
ANGELA PORTER LISENBY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
34 WHITE OAK TRL, BLACK MOUNTAIN, NC 28711-8782
(404) 358-8461
Mailing address
34 WHITE OAK TRL, BLACK MOUNTAIN, NC 28711-8782
(404) 358-8461
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT004231
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
127157301A
—
GA
05
—
641695989A
—
GA
05
—
814307358A
—
GA
05
—
814307358B
—
GA
Enumeration date
01/05/2006
Last updated
01/23/2018
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