Individual
LISA G NATHANSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
11380 FRY RD, EDINBORO, PA 16412-1004
(814) 734-1358
Mailing address
11380 FRY RD, EDINBORO, PA 16412-1004
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OC001044L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1011618870002
—
PA
Enumeration date
01/12/2007
Last updated
07/09/2007
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