MEDICARE: MS. LISA DOTSON WARD 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
1	225X00000X	Occupational Therapist	105145	TX
2	225X00000X	Occupational Therapist	OT12827	FL

General Provider Information

NPI Number	:	1376830448
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LISA DOTSON WARD OTR

Provider Business Mailing Address
First Line	:	5011 OAK LN
Second Line	:
City	:	TEXAS CITY
State	:	TX
Zip	:	77591-4616
Country	:	US
Telephone Number	:	409-789-4307
Fax Number	:

Provider Business Practice Location Address
First Line	:	5011 OAK LN
Second Line	:
City	:	TEXAS CITY
State	:	TX
Zip	:	77591-4616
Country	:	US
Telephone Number	:	409-789-4307
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2011
Last Update Date	:	07/08/2011

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