Individual
LISA KELM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Taxonomy
Speciality
Code
Description
License number
State
225XH1200X
Hand Occupational Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
240520
—
OR
01
—
800895103
REGENCE MEDADVANTAGE
OR
01
—
838406003
REGENCE BLUE CROSS BLUE SHEILD
OR
Enumeration date
02/12/2007
Last updated
06/18/2012
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