Lisa Ann Nicholson, OTR/L
Individual provider Active NPI Pediatric Occupational Therapist · Avoca, NY
NPI 1689820060 · NPPES record last updated Dec 23, 2011
Key facts
- NPI
- 1689820060
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatric Occupational Therapist 225XP0200X
- License
- 012016-1 (NY)
- Practice address
- 8992 Hemlock Road
Avoca, NY 14809 - Phone
- (607) 566-3407
- NPI assigned
- Aug 17, 2008
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 012016-1 | NY | MD | Physician Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Occupational Therapist | 225XP0200X | 012016-1 | NY | Yes |
Addresses
Primary practice location
8992 Hemlock Road
Avoca, NY 14809
Mailing address
8992 Hemlock Rd
Avoca, NY 14809-9777
Other providers in Avoca, NY
- Emiy Eckel
- Kayla Emo
- Abbagail Flack
- Ellen M Gronski
- Deborah J. Hunt
- Margarita Paider
- Sara Schiele
- Delaney Kristine Stowe
All providers in Avoca, NY · Pediatric Occupational Therapist in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 23, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.