=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235559485
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LISA HORCHLER MS, CCC-SLP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/25/2014
-----------------------------------------------------
Last Update Date | 04/25/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 TWIN OAKS DR
-----------------------------------------------------
City | MILAN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44846-9488
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-499-9999
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 TWIN OAKS DR
-----------------------------------------------------
City | MILAN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44846-9488
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-499-9999
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | SP.7541
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------