Individual
MRS. LISA ROSE HICKEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
211 EDGEWOOD AVE, PLEASANTVILLE, NY 10570-2048
(914) 500-5788
Mailing address
211 EDGEWOOD AVE, PLEASANTVILLE, NY 10570-2048
(914) 747-1861
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
008098-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
008098
REGISTRATION CERTIFICATE, LICENSE #
NY
Enumeration date
12/01/2008
Last updated
12/01/2008
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