Organization
LISA H WISTER, INC
Active
Other names
Lisa H Wister, Inc
Organization subpart
No
Provider details
NPI number
Authorized official
LISA H WISTER OT (CHIEF OFFICER)
(773) 230-3365
Entity
Organization
Contact information
Practice address
923 S HUMPHREY AVE, OAK PARK, IL 60304-1720
(773) 230-3365
(855) 392-6998
Mailing address
923 S HUMPHREY AVE, OAK PARK, IL 60304-1720
(773) 230-3365
(855) 392-6998
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
056007137
IL
252Y00000X
Early Intervention Provider Agency
056007137
IL
Other
Enumeration date
01/18/2018
Last updated
01/18/2018
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