MEDICARE: LISA BECK KING 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	OT005877	GA

General Provider Information

NPI Number	:	1316702442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA BECK KING OTR/L

Provider Business Mailing Address
First Line	:	30 KOTAL CIR
Second Line	:
City	:	CANON
State	:	GA
Zip	:	30520-3528
Country	:	US
Telephone Number	:	919-349-8164
Fax Number	:

Provider Business Practice Location Address
First Line	:	30 KOTAL CIR
Second Line	:
City	:	CANON
State	:	GA
Zip	:	30520-3528
Country	:	US
Telephone Number	:	919-349-8164
Fax Number	:

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

Provider Enumeration Date	:	02/19/2024
Last Update Date	:	02/19/2024

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