Individual
LISA M FOWLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTRL, CHT
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
1867
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6013520001
MEDICARE PTAN DME
AZ
01
—
86059251885704C007
TRICARE NUMBER
AZ
Enumeration date
07/05/2005
Last updated
02/01/2016
Update your record
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