MEDICARE: LISA PUTMAN

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	106155	TX

General Provider Information

NPI Number	:	1245691708
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA PUTMAN

Provider Business Mailing Address
First Line	:	1101 S CAPITAL OF TEXAS HWY STE G200
Second Line	:
City	:	WEST LAKE HILLS
State	:	TX
Zip	:	78746-6480
Country	:	US
Telephone Number	:	800-967-4667
Fax Number	:

Provider Business Practice Location Address
First Line	:	1101 S CAPITAL OF TEXAS HWY STE G200
Second Line	:
City	:	WEST LAKE HILLS
State	:	TX
Zip	:	78746-6480
Country	:	US
Telephone Number	:	800-967-4667
Fax Number	:

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

Provider Enumeration Date	:	03/11/2016
Last Update Date	:	03/11/2016

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Directions to “ LISA PUTMAN ” Practice Location

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