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NPI Code Detail

MEDICARE: LISA A RENOCK OTR

MEDICARE: LISA A RENOCK OTR
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist006445OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1093912529
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA A RENOCK OTR
Provider Business Mailing Address
First Line : 130 COLONIAL DR
Second Line :
City : LOVELAND
State : OH
Zip : 45140-7901
Country : US
Telephone Number : 513-490-4597
Fax Number :
Provider Business Practice Location Address
First Line : 1879 DEERFIELD RD
Second Line :
City : LEBANON
State : OH
Zip : 45036-8602
Country : US
Telephone Number : 513-695-2300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/28/2007
Last Update Date : 01/29/2016

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