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General NPI Number Information
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NPI Number | 1316016736
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Entity Type | Individual
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Provider Name | CHRISTIE LEZON OTRL
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Gender | Female
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Dates
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Enumeration Date | 11/07/2006
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Last Update Date | 06/01/2018
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Provider Practice Location Address
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Address Line | 3100 WASHINGTON RD
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City | KENOSHA
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State | WI
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Zip | 53144
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Country | US
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Telephone | 262-658-4622
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Fax |
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Provider Business Mailing Address
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Address Line | 3512 N BRITTON RD
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City | UNION GROVE
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State | WI
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Zip | 53182-9663
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 56004966
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 2908
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License Number State | WI
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