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NPI Code Detail

MEDICARE: LISA MRSNY OTR/L, PAM

MEDICARE: LISA MRSNY OTR/L, PAM
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
1225X00000XOccupational Therapist169000CA

General Provider Information

NPI Number : 1679181960
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA MRSNY OTR/L, PAM
Provider Business Mailing Address
First Line : 890 EL CAMINO REAL
Second Line :
City : SAN BRUNO
State : CA
Zip : 94066-3137
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 890 EL CAMINO REAL
Second Line :
City : SAN BRUNO
State : CA
Zip : 94066-3137
Country : US
Telephone Number : 650-922-0344
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/22/2020
Last Update Date : 07/22/2020

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