Individual
LISA DIANE VAUGHN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1209 MARIETTA DR, FAIRBORN, OH 45324-5726
(937) 657-2204
Mailing address
1209 MARIETTA DR, FAIRBORN, OH 45324-5726
(937) 657-2204
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
006264
OH
Other
Enumeration date
02/04/2019
Last updated
02/04/2019
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