MEDICARE: MS. LISA RENEE WAXMAN OTR

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	174400000X	Specialist	OT 981	FL

General Provider Information

NPI Number	:	1275554677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LISA RENEE WAXMAN OTR

Provider Business Mailing Address
First Line	:	13290 BISCAYNE BAY TER
Second Line	:
City	:	NORTH MIAMI
State	:	FL
Zip	:	33181-2230
Country	:	US
Telephone Number	:	305-899-9665
Fax Number	:	305-895-0015

Provider Business Practice Location Address
First Line	:	13290 BISCAYNE BAY TER
Second Line	:
City	:	NORTH MIAMI
State	:	FL
Zip	:	33181-2230
Country	:	US
Telephone Number	:	305-899-9665
Fax Number	:	305-895-0015

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

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	07/08/2007

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