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NPI Code Detail

MEDICARE: MRS. REBECCA R LISY OT

MEDICARE: MRS. REBECCA R LISY OT
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 Therapist1187NC

General Provider Information

NPI Number : 1629052949
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. REBECCA R LISY OT
Provider Business Mailing Address
First Line : 4601 PARK RD
Second Line : STE 300
City : CHARLOTTE
State : NC
Zip : 28209-3239
Country : US
Telephone Number : 704-323-2000
Fax Number :
Provider Business Practice Location Address
First Line : 2400 W MALLARD CREEK CHURCH RD
Second Line :
City : CHARLOTTE
State : NC
Zip : 28262-2324
Country : US
Telephone Number : 704-323-2108
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/30/2005
Last Update Date : 12/17/2024

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