Individual
MS. LISA MARIE MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
4444 FOREST PARK AVE, SAINT LOUIS, MO 63108-2212
(314) 286-1096
(314) 286-1601
Mailing address
4444 FOREST PARK AVE, C B 8505, SAINT LOUIS, MO 63108-2212
(314) 286-1600
(314) 286-1601
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
2004002630
MO
Other
Enumeration date
08/30/2006
Last updated
09/19/2013
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