Individual
LISA ANNE BLACKWOOD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
1515 JOHNSON FERRY RD, MARIETTA, GA 30062-6492
(770) 977-9457
Mailing address
1515 JOHNSON FERRY RD, MARIETTA, GA 30062-6492
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
113286
TX
225X00000X
Occupational Therapist
OT008480
GA
Other
Enumeration date
03/29/2010
Last updated
02/01/2024
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