MEDICARE: DR. LISA GRAVES WOODING OTD

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	11891	NC

General Provider Information

NPI Number	:	1629506431
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA GRAVES WOODING OTD

Provider Business Mailing Address
First Line	:	3500 DEPAUW BLVD STE 3070
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46268-6135
Country	:	US
Telephone Number	:	855-324-0885
Fax Number	:	317-520-8200

Provider Business Practice Location Address
First Line	:	4510 PREMIER DR
Second Line	:
City	:	HIGH POINT
State	:	NC
Zip	:	27265-8193
Country	:	US
Telephone Number	:	336-568-6122
Fax Number	:	317-520-8200

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

Provider Enumeration Date	:	05/24/2017
Last Update Date	:	05/19/2025

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