MEDICARE: LISA MICHELE RAYMOND-TOLAN 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	225XP0200X	Pediatric Occupational Therapist	014994-1	NY

General Provider Information

NPI Number	:	1720213424
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA MICHELE RAYMOND-TOLAN OTR/L

Provider Business Mailing Address
First Line	:	362 15TH ST
Second Line	:	APT 1R
City	:	BROOKLYN
State	:	NY
Zip	:	11215-5680
Country	:	US
Telephone Number	:	646-932-1989
Fax Number	:

Provider Business Practice Location Address
First Line	:	532 COURT ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11231-3986
Country	:	US
Telephone Number	:	718-254-0800
Fax Number	:

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

Provider Enumeration Date	:	05/26/2009
Last Update Date	:	05/26/2009

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