Individual
MRS. PHYLLIS HOUSTON DISHNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
628 LAKE ST NE, WISE, VA 24293-7919
(276) 275-1500
Mailing address
518 POWELL AVE E, BIG STONE GAP, VA 24219-2346
(276) 275-1500
(276) 275-1500
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
0131000931
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8409140
INSURANCE BROKER
VA
Enumeration date
10/13/2017
Last updated
10/13/2017
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