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NPI Code Detail

MEDICARE: LISA LYNN RUDOLPH

MEDICARE: LISA LYNN RUDOLPH
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
1224Z00000XOccupational Therapy Assistant04768OH

General Provider Information

NPI Number : 1225389760
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA LYNN RUDOLPH
Provider Business Mailing Address
First Line : 10383 CALVARY RD
Second Line :
City : INDEPENDENCE
State : KY
Zip : 41051-9663
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 230 W GALBRAITH RD
Second Line :
City : CINCINNATI
State : OH
Zip : 45215-5223
Country : US
Telephone Number : 513-948-2308
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/24/2012
Last Update Date : 09/24/2012

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