Individual
MRS. LISA IRENE PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
125 MIDDLETOWN RD, WATERFORD, NY 12188-1516
(518) 237-0800
(518) 687-2643
Mailing address
125 MIDDLETOWN RD, WATERFORD, NY 12188-1516
(518) 237-0800
(518) 687-2643
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
02203-1
NY
Other
Enumeration date
11/13/2019
Last updated
11/13/2019
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