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General NPI Number Information
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NPI Number | 1073077343
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Entity Type | Individual
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Provider Name | LISA MARLENE THOMPSON-GOERTZ OTR/L
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Gender | Female
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Dates
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Enumeration Date | 01/30/2019
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Last Update Date | 01/03/2021
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Provider Practice Location Address
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Address Line | 9280 SW 81ST CT
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City | OCALA
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State | FL
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Zip | 34481-7848
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Country | US
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Telephone | 352-509-5201
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Fax |
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Provider Business Mailing Address
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Address Line | 2844 SE 6TH ST
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City | OCALA
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State | FL
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Zip | 34471-2775
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Country | US
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Telephone | 352-207-2534
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT16797
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 225XN1300X
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Taxonomy Name | Neurorehabilitation Occupational Therapist
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License Number | OT16797
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License Number State | FL
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