Healthcare Provider Details

I. General information

NPI: 1811282288
Provider Name (Legal Business Name): LISA GOLDEN MORSE OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2011
Last Update Date: 06/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 MAHON ST
LEBANON NH
03766
US

IV. Provider business mailing address

PO BOX 493
HARTLAND VT
05048-0493
US

V. Phone/Fax

Practice location:
  • Phone: 603-443-9639
  • Fax:
Mailing address:
  • Phone: 802-299-7930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1931
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number072.0000554
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: