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General NPI Number Information
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NPI Number | 1801394812
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Entity Type | Individual
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Provider Name | LIZA BOURDON MS OTR/L
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Gender | Female
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Dates
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Enumeration Date | 01/24/2018
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 89 MADISON ST
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City | CORTLAND
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State | NY
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Zip | 13045-1712
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Country | US
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Telephone | 607-758-4160
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Fax |
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Provider Business Mailing Address
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Address Line | 204 TOWNLINE RD
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City | NEWFIELD
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State | NY
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Zip | 14867-9249
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Country | US
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Telephone |
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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 | 022062
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License Number State | NY
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