MEDICARE: LISA ZHANG MOT,OTR/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
1	225XH1200X	Hand Occupational Therapist	0119006665	VA
2	225X00000X	Occupational Therapist	0119006665	VA

General Provider Information

NPI Number	:	1841673092
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA ZHANG MOT,OTR/L

Provider Business Mailing Address
First Line	:	14348 GIDEON DR
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22192-4640
Country	:	US
Telephone Number	:	703-490-1112
Fax Number	:	703-878-8732

Provider Business Practice Location Address
First Line	:	14348 GIDEON DR
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22192-4640
Country	:	US
Telephone Number	:	703-490-1112
Fax Number	:	703-878-8732

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

Provider Enumeration Date	:	07/07/2015
Last Update Date	:	04/05/2021

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