Individual
LISA MARIE ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
5269 GREEN VALLEY DR, CLARENCE, NY 14031-1231
(716) 348-6294
Mailing address
5269 GREEN VALLEY DR, CLARENCE, NY 14031-1231
(716) 348-6294
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
010249
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010249
—
NY
Enumeration date
01/03/2020
Last updated
01/03/2020
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