Individual
MRS. LISA M HARRELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.O.T.
Contact information
Practice address
2473 BLUFF CT, MANDEVILLE, LA 70448-8478
(985) 590-1865
Mailing address
2473 BLUFF CT, MANDEVILLE, LA 70448-8478
(985) 590-1865
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OTT.200550
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OTT.200550
LSBME OT LICENSE NUMBER
LA
Enumeration date
09/05/2012
Last updated
09/05/2012
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