Individual
LISA DEZIEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
605 SOUTHFIELD PL, ALPHARETTA, GA 30004-4255
(404) 429-8291
Mailing address
605 SOUTHFIELD PL, ALPHARETTA, GA 30004-4255
(770) 752-4734
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
OT003055
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000964873B
—
GA
Enumeration date
09/02/2006
Last updated
03/18/2010
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