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General NPI Number Information
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NPI Number | 1609910280
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Entity Type | Individual
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Provider Name | LISA GERARD FAULISE MS
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Gender | Female
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Dates
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Enumeration Date | 02/16/2007
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Last Update Date | 08/09/2024
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Provider Practice Location Address
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Address Line | 20 NEWMAN AVE. SUITE 1025
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City | RUMFORD
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State | RI
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Zip | 02916
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Country | US
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Telephone | 401-610-0639
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Fax |
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Provider Business Mailing Address
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Address Line | 15 LOOP DRIVE
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City | NORTH KINGSTON
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State | RI
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Zip | 02852
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Country | US
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Telephone | 401-610-0639
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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 | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 000116
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License Number State | RI
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Taxonomy #2
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | MO2005013549
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License Number State | MO
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