Provider Demographics
NPI:1508085895
Name:LYSON, STEPHANIE LYNN (OTR)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LYNN
Last Name:LYSON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:LYNN
Other - Last Name:BEKKEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:PO BOX 1575
Mailing Address - Street 2:SUITE 102
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58602-1575
Mailing Address - Country:US
Mailing Address - Phone:701-483-1257
Mailing Address - Fax:
Practice Address - Street 1:2893 3RD AVE W
Practice Address - Street 2:102
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-2617
Practice Address - Country:US
Practice Address - Phone:701-483-1257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND965225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist