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General NPI Number Information
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NPI Number | 1518840305
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Entity Type | Individual
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Provider Name | LISA IRVINE MS OTR/L RYT200
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Gender | Female
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Dates
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Enumeration Date | 07/29/2025
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Last Update Date | 07/29/2025
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Provider Practice Location Address
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Address Line | 37 PIERCE ST
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City | NORTHBOROUGH
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State | MA
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Zip | 01532-1935
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Country | US
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Telephone | 508-330-1141
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Fax |
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Provider Business Mailing Address
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Address Line | 299 CLARK ROAD EXT
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City | FISKDALE
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State | MA
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Zip | 01518-1036
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Country | US
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Telephone | 508-330-1141
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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 | OT10132
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License Number State | MA
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