Individual
MISS LISA JANE EVANS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
15 PARKMAN ST, BOSTON, MA 02114-3117
(617) 724-0147
(617) 726-3004
Mailing address
106 13TH ST APT 212, CHARLESTOWN, MA 02129-2066
(617) 242-0508
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
8108
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8108
PROFESSIONAL LICENSE
MA
Enumeration date
02/22/2007
Last updated
07/08/2007
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