Provider Demographics
NPI:1225272321
Name:LISAK, JANET M (MOT,OTR,CHT)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:M
Last Name:LISAK
Suffix:
Gender:F
Credentials:MOT,OTR,CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 WEST MAIN STREET
Mailing Address - Street 2:BUILDING 2, THE HAND TO SHOULDER CENTER, LLC
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708
Mailing Address - Country:US
Mailing Address - Phone:203-755-7115
Mailing Address - Fax:203-755-7067
Practice Address - Street 1:1320 WEST MAIN STREET
Practice Address - Street 2:BUILDING 2, THE HAND TO SHOULDER CENTER, LLC
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708
Practice Address - Country:US
Practice Address - Phone:203-755-7115
Practice Address - Fax:203-755-7067
Is Sole Proprietor?:No
Enumeration Date:2009-04-21
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003534225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist