MEDICARE: LISA DUCHESNE MS, OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	2078	NH

General Provider Information

NPI Number	:	1134433881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA DUCHESNE MS, OTR/L

Provider Business Mailing Address
First Line	:	143 COURT ST
Second Line	:
City	:	EXETER
State	:	NH
Zip	:	03833-4025
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	364 CATES HILL RD
Second Line	:
City	:	BERLIN
State	:	NH
Zip	:	03570-1554
Country	:	US
Telephone Number	:	603-752-2343
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2010
Last Update Date	:	05/20/2016

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