| NPI | 1992213417 |
|---|---|
| Former Legal Business Name | LISA H WISTER, INC |
| Entity Type | Organization |
| Authorized Contact | LISA H WISTER Chief Officer 773-230-3365 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225XP0200X Occupational Therapist, Pediatrics (Licence: IL 056007137) |
| Additional Taxonomies | 252Y00000X Early Intervention Provider Agency (Licence: IL 056007137) |
| Enumeration Date | 2018-01-18 |
| Last Update Date | 2018-01-18 |