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General NPI Number Information
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NPI Number | 1386768133
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Entity Type | Individual
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Provider Name | LISA MARIE FORE OTR, CEAS
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Gender | Female
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 01/24/2019
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Provider Practice Location Address
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Address Line | 1000 W CROSBY RD STE 136
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City | CARROLLTON
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State | TX
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Zip | 75006-6904
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Country | US
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Telephone | 817-658-8808
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Fax |
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Provider Business Mailing Address
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Address Line | 4001 TARA DR
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City | COLLEYVILLE
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State | TX
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Zip | 76034-4106
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Country | US
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Telephone | 178-658-8808
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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 | 106656
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License Number State | TX
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