Healthcare Provider Details

I. General information

NPI: 1922253160
Provider Name (Legal Business Name): LILY BAISER MS OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2008
Last Update Date: 03/04/2024
Certification Date: 03/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4708 NW 70TH LN
GAINESVILLE FL
32653-1154
US

IV. Provider business mailing address

4708 NW 70TH LN
GAINESVILLE FL
32653-1154
US

V. Phone/Fax

Practice location:
  • Phone: 352-219-8114
  • Fax:
Mailing address:
  • Phone: 352-219-8114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number014559-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: