Individual
LISA SHADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2125 ELIZABETH AVE, LAURELDALE, PA 19605-2259
(610) 921-9292
Mailing address
815 SLEEPY HOLLOW DR, MOHRSVILLE, PA 19541-8626
(484) 345-1408
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OP003431L
PA
Other
Enumeration date
12/14/2023
Last updated
12/14/2023
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