Healthcare Provider Details

I. General information

NPI: 1598910416
Provider Name (Legal Business Name): LISA S GOLOD OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2008
Last Update Date: 08/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

666 PLAINSBORO RD STE 2000C
PLAINSBORO NJ
08536-3048
US

IV. Provider business mailing address

1255 CALDWELL RD
CHERRY HILL NJ
08034-3220
US

V. Phone/Fax

Practice location:
  • Phone: 877-407-3422
  • Fax: 877-407-4329
Mailing address:
  • Phone: 856-348-1209
  • Fax: 856-429-4755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number46TR00228500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: