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General NPI Number Information
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NPI Number | 1104884196
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Entity Type | Individual
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Provider Name | LISA SLAY JARRIEL PTA
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Gender | Female
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Dates
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Enumeration Date | 05/02/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 332 SW 32ND STREET
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City | OKEECHOBEE
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State | FL
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Zip | 34974
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Country | US
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Telephone | 863-467-6669
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Fax | 863-467-6674
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Provider Business Mailing Address
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Address Line | 2457 SW 9TH LANE
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City | OKEECHOBEE
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State | FL
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Zip | 34974
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Country | US
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Telephone | 863-467-6669
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Fax | 863-467-6674
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA19185
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License Number State | FL
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