Basic Information
| Provider Information | |||||||||
| NPI: | 1407203565 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NAUGLE | ||||||||
| FirstName: | LISA | ||||||||
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| Credential: | COTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5 LINCOLN DR | ||||||||
| Address2: | |||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172221007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7173522268 | ||||||||
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| Practice Location | |||||||||
| Address1: | 56 W FREDERICK ST | ||||||||
| Address2: | |||||||||
| City: | WALKERSVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217938254 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3018984300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2016 | ||||||||
| LastUpdateDate: | 05/18/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | A02316 | MD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant | 224Z00000X | OP008387 | PA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.