Individual
LISA RUTH MEDVENE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
25501 POLARIS LN, LAKE FOREST, CA 92630-4921
(714) 222-5748
Mailing address
25501 POLARIS LN, LAKE FOREST, CA 92630-4921
(714) 222-5748
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
1847
CA
Other
Enumeration date
01/15/2015
Last updated
01/15/2015
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