Healthcare Provider Details

I. General information

NPI: 1821170713
Provider Name (Legal Business Name): SHEREEN MIZANY OTR / L, MOT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 S K ST # B
LOMPOC CA
93436-7230
US

IV. Provider business mailing address

PO BOX 1293
LOMPOC CA
93438-1293
US

V. Phone/Fax

Practice location:
  • Phone: 805-735-7291
  • Fax:
Mailing address:
  • Phone: 818-212-8148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number3567 THERAPY SERVICE
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number3567 O.T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: