Individual
LISA SIDES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1485 INTERNATIONAL PKWY, HEATHROW, FL 32746-5303
(800) 798-6035
Mailing address
453 VICTORIAN LN, GRANITE FALLS, NC 28630-8663
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
1644
NC
Other
Enumeration date
09/26/2007
Last updated
09/26/2007
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