Individual
MRS. LISA RENEE BODEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
563 COLONY PARK DR, TALLMADGE, OH 44278-2859
(330) 630-9780
Mailing address
563 COLONY PARK DR, TALLMADGE, OH 44278-2859
(330) 630-9780
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
03952
OH
Other
Enumeration date
06/24/2010
Last updated
06/24/2010
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