Individual
LISA MARIE LICHAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
731 PRE EMPTION RD, GENEVA, NY 14456-1335
(315) 789-6828
Mailing address
731 PRE EMPTION RD, GENEVA, NY 14456-1335
(315) 789-6828
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
005890-1
NY
Other
Enumeration date
08/14/2008
Last updated
08/14/2008
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