Individual
MRS. LISA ANN WADHAMS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
65 COOPER ST, AGAWAM, MA 01001
(413) 786-8000
Mailing address
222 MOUNTAIN RD, ELLINGTON, CT 06029
(860) 896-0008
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
3071
MA
Other
Enumeration date
08/14/2007
Last updated
08/14/2007
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