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General NPI Number Information
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NPI Number | 1629145917
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Entity Type | Organization
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Legal Business Name | LISA E. CYZNER, PHD, OTRL
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Dates
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Enumeration Date | 11/29/2006
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Last Update Date | 12/11/2007
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Provider Practice Location Address
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Address Line | 6401 CARMEL RD SUITE 101
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City | CHARLOTTE
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State | NC
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Zip | 28226-8279
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Country | US
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Telephone | 704-542-9473
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Fax | 704-752-4348
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Provider Business Mailing Address
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Address Line | 6401 CARMEL RD SUITE 101
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City | CHARLOTTE
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State | NC
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Zip | 28226-8279
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Country | US
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Telephone | 704-542-9473
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Fax | 704-752-4348
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Authorized Official
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Title or Position | OWNER AND DIRECTOR
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Name | DR. LISA ELLEN CYZNER
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Credential | PHD OTRL
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Telephone | 704-542-9473
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 4095
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License Number State | NC
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