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NPI Code Detail

MEDICARE: MRS. LISA FRANCINE BROUILLETTE OT/L

MEDICARE: MRS. LISA FRANCINE BROUILLETTE OT/L
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 Therapist003314-1NY

General Provider Information

NPI Number : 1700173952
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LISA FRANCINE BROUILLETTE OT/L
Provider Business Mailing Address
First Line : 352 GROS BLVD
Second Line :
City : HERKIMER
State : NY
Zip : 13350-1446
Country : US
Telephone Number : 315-867-2000
Fax Number : 315-867-2040
Provider Business Practice Location Address
First Line : 352 GROS BLVD
Second Line :
City : HERKIMER
State : NY
Zip : 13350-1446
Country : US
Telephone Number : 315-867-2000
Fax Number : 315-867-2400
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2011
Last Update Date : 07/07/2011

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