Individual
LISA PELO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATP, OTR
Contact information
Practice address
4009 LINDBERGH DR, ADDISON, TX 75001-4343
(972) 428-3739
Mailing address
5309 KARA LN, PARKER, TX 75002-6309
(214) 886-0522
(972) 418-7786
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
106463
TX
247200000X
Other Technician
Primary
84320
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010980303
—
TX
Enumeration date
08/19/2014
Last updated
08/19/2014
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