Healthcare Provider Details

I. General information

NPI: 1487780953
Provider Name (Legal Business Name): CHRISTINE LISHOK MS OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTINE SODAK, MAJOR, ARGUST

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 09/25/2020
Certification Date: 09/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1068 MARSHBROOK RD
FACTORYVILLE PA
18419-9608
US

IV. Provider business mailing address

RR 2 BOX 2295
FACTORYVILLE PA
18419-9628
US

V. Phone/Fax

Practice location:
  • Phone: 570-510-0516
  • Fax:
Mailing address:
  • Phone: 570-222-5687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number0138991
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOC009944
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOC009944
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: