MEDICARE: MS. LISA MARIE ROBINSON OT/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	OT-004587	OH
2	225XN1300X	Neurorehabilitation Occupational Therapist	OT-004587	OH

General Provider Information

NPI Number	:	1558655837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LISA MARIE ROBINSON OT/L

Provider Business Mailing Address
First Line	:	350 WINCHESTER ST
Second Line	:
City	:	NEW CARLISLE
State	:	OH
Zip	:	45344-3029
Country	:	US
Telephone Number	:	937-732-1111
Fax Number	:

Provider Business Practice Location Address
First Line	:	350 WINCHESTER ST
Second Line	:
City	:	NEW CARLISLE
State	:	OH
Zip	:	45344-3029
Country	:	US
Telephone Number	:	937-732-1111
Fax Number	:

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

Provider Enumeration Date	:	06/04/2011
Last Update Date	:	03/13/2016

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