Individual
TISA LASAY DILLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
60 BRIMLEY DR, FREDERICKSBURG, VA 22406-5148
(540) 737-4505
Mailing address
60 BRIMLEY DR, FREDERICKSBURG, VA 22406-5148
(540) 737-4505
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
0119005728
VA
225X00000X
Occupational Therapist
06873
MD
Other
Enumeration date
07/30/2013
Last updated
07/30/2013
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