MEDICARE: LISA HIELSCHER MS 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	OT 9007	CA

General Provider Information

NPI Number	:	1821231317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA HIELSCHER MS OTR/L

Provider Business Mailing Address
First Line	:	2722 GOUGH ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94123-4405
Country	:	US
Telephone Number	:	415-775-5511
Fax Number	:	415-775-5521

Provider Business Practice Location Address
First Line	:	2722 GOUGH ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94123-4405
Country	:	US
Telephone Number	:	415-775-5511
Fax Number	:	415-775-5521

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

Provider Enumeration Date	:	04/13/2009
Last Update Date	:	04/13/2009

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