MEDICARE: LISA M FOWLER OTRL, CHT

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	1867	AZ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	6013520001	OTHER	AZ	MEDICARE PTAN DME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	86059251885704C007	OTHER	AZ	TRICARE NUMBER

General Provider Information

NPI Number	:	1609873777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA M FOWLER OTRL, CHT

Provider Business Mailing Address
First Line	:	4172 W PYRACANTHA CIR
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85741-1339
Country	:	US
Telephone Number	:	520-400-0726
Fax Number	:	520-293-5454

Provider Business Practice Location Address
First Line	:	437 W THURBER RD
Second Line	:	STE 2
City	:	TUCSON
State	:	AZ
Zip	:	85705-6822
Country	:	US
Telephone Number	:	520-293-5252
Fax Number	:	520-293-5454

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

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	02/01/2016

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