MEDICARE: LISA CHAMBERS OT

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	105842	TX

General Provider Information

NPI Number	:	1861799181
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA CHAMBERS OT

Provider Business Mailing Address
First Line	:	704 N OAK ST
Second Line	:
City	:	ROANOKE
State	:	TX
Zip	:	76262-8502
Country	:	US
Telephone Number	:	817-723-8680
Fax Number	:

Provider Business Practice Location Address
First Line	:	5601 BRIDGE ST STE 490
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76112-2306
Country	:	US
Telephone Number	:	817-446-5000
Fax Number	:	817-332-7801

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

Provider Enumeration Date	:	02/23/2011
Last Update Date	:	02/23/2011

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Directions to “ LISA CHAMBERS OT” Practice Location

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