Individual
MRS. LISA MICHELLE WATERMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
5107 LEATHERBACK RD, WOODBRIDGE, VA 22193-5835
(571) 285-4383
Mailing address
5107 LEATHERBACK RD, WOODBRIDGE, VA 22193-5835
(571) 285-4383
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
0131001073
VA
Other
Enumeration date
01/05/2013
Last updated
01/05/2013
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