Individual
MRS. LISA MARIE DEBOER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
365 ASTER RIDGE TRL, PEACHTREE CITY, GA 30269-3049
(605) 351-9764
Mailing address
365 ASTER RIDGE TRL, PEACHTREE CITY, GA 30269-3049
(605) 351-9764
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT006005
GA
225XG0600X
Gerontology Occupational Therapist
0579
SD
225XP0200X
Pediatric Occupational Therapist
OT006005
GA
Other
Enumeration date
03/03/2011
Last updated
08/03/2015
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