Healthcare Provider Details

I. General information

NPI: 1003018326
Provider Name (Legal Business Name): LISA M CODY OT CHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 01/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 N ORANGE AVE STE 610
ORLANDO FL
32801-1026
US

IV. Provider business mailing address

801 N ORANGE AVE STE 610
ORLANDO FL
32801-1026
US

V. Phone/Fax

Practice location:
  • Phone: 407-228-0588
  • Fax:
Mailing address:
  • Phone: 407-228-0588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License NumberOT2792
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: