| NPI | 1457572034 |
|---|---|
| Former Name | LISA TRACY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 014901) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: MA 9017) |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2018-09-10 |