Individual
MS. LISA HARE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTAL
Contact information
Practice address
8015 LAWNDALE AVE, PHILADELPHIA, PA 19111-1507
(215) 725-2525
Mailing address
558 E WOODLAWN ST, PHILADELPHIA, PA 19144-1316
(610) 905-6896
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OP001330L
PA
Other
Enumeration date
03/20/2007
Last updated
07/08/2007
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