Provider Demographics
NPI:1083704092
Name:PAWLYSZYN, LYDIA S (OTR/L, CHT)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:S
Last Name:PAWLYSZYN
Suffix:
Gender:F
Credentials:OTR/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10165 LYNN DR
Mailing Address - Street 2:
Mailing Address - City:N ROYALTON
Mailing Address - State:OH
Mailing Address - Zip Code:44133-1425
Mailing Address - Country:US
Mailing Address - Phone:440-582-4362
Mailing Address - Fax:
Practice Address - Street 1:18697 BAGLEY RD
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-3417
Practice Address - Country:US
Practice Address - Phone:440-816-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH000937225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0842995Medicaid
OH000000217474OtherANTHEM BLUE CROSS AND BLU
OH4655AOtherBEECH STREET CORPORATION
OH4655AOtherBEECH STREET CORPORATION