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General NPI Number Information
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NPI Number | 1134221823
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Entity Type | Individual
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Provider Name | LISA DEZIEL OT
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Gender | Female
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Dates
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Enumeration Date | 09/02/2006
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Last Update Date | 03/18/2010
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Provider Practice Location Address
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Address Line | 605 SOUTHFIELD PL
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City | ALPHARETTA
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State | GA
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Zip | 30004-4255
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Country | US
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Telephone | 404-429-8291
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Fax |
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Provider Business Mailing Address
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Address Line | 605 SOUTHFIELD PL
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City | ALPHARETTA
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State | GA
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Zip | 30004-4255
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Country | US
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Telephone | 770-752-4734
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | OT003055
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License Number State | GA
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