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NPI Code Detail

MEDICARE: LISA B MEWSHAW MS, OTR/L

MEDICARE: LISA B MEWSHAW 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
1225X00000XOccupational Therapist1585WV

General Provider Information

NPI Number : 1912254343
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA B MEWSHAW MS, OTR/L
Provider Business Mailing Address
First Line : 73 HOLLY SPRINGS DR
Second Line :
City : CHARLES TOWN
State : WV
Zip : 25414-4771
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 50 MULBERRY TREE ST
Second Line :
City : CHARLES TOWN
State : WV
Zip : 25414-1274
Country : US
Telephone Number : 304-724-1101
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/03/2012
Last Update Date : 08/03/2012

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