MEDICARE: LISA KNIERIM ESKINS 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	1124	WV

General Provider Information

NPI Number	:	1912022237
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA KNIERIM ESKINS OT

Provider Business Mailing Address
First Line	:	1097 BROOKINGS DR
Second Line	:
City	:	MORGANTOWN
State	:	WV
Zip	:	26508-8739
Country	:	US
Telephone Number	:	304-292-0098
Fax Number	:

Provider Business Practice Location Address
First Line	:	1543 COUNTRY CLUB RD
Second Line	:
City	:	FAIRMONT
State	:	WV
Zip	:	26554-1306
Country	:	US
Telephone Number	:	304-363-4599
Fax Number	:

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

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	07/08/2007

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