Provider Demographics
NPI:1316014608
Name:CYZNER, LISA ELLEN (PHD OTRL)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:ELLEN
Last Name:CYZNER
Suffix:
Gender:F
Credentials:PHD OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6401 CARMEL RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-8279
Mailing Address - Country:US
Mailing Address - Phone:704-542-9473
Mailing Address - Fax:704-752-4348
Practice Address - Street 1:6401 CARMEL RD
Practice Address - Street 2:SUITE 101
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-8279
Practice Address - Country:US
Practice Address - Phone:704-542-9473
Practice Address - Fax:704-752-4348
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4095225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7301945Medicaid