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General NPI Number Information
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NPI Number | 1952700544
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Entity Type | Individual
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Provider Name | LISA PELO ATP, OTR
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Gender | Female
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Dates
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Enumeration Date | 08/19/2014
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Last Update Date | 08/19/2014
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Provider Practice Location Address
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Address Line | 4009 LINDBERGH DR
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City | ADDISON
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State | TX
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Zip | 75001-4343
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Country | US
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Telephone | 972-428-3739
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Fax |
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Provider Business Mailing Address
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Address Line | 5309 KARA LN
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City | PARKER
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State | TX
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Zip | 75002-6309
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Country | US
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Telephone | 214-886-0522
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Fax | 972-418-7786
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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 | 106463
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 247200000X
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Taxonomy Name | Other Technician
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License Number | 84320
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License Number State | TX
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