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Individual

LISA BLACKWELL

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
3006 W OXFORD ST, PHILA, PA 19121-3512
(215) 763-7288
Mailing address
3006 W OXFORD ST, PHILA, PA 19121-3512

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OC003204L
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0019384870003
PA
Enumeration date
04/30/2008
Last updated
05/19/2008
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