Provider Demographics
NPI:1528569514
Name:CIZEK, TYLER (OTR)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:CIZEK
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 MONROE AVE NW UNIT 214
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-1458
Mailing Address - Country:US
Mailing Address - Phone:616-566-5142
Mailing Address - Fax:
Practice Address - Street 1:1684 VULCAN ST
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-6070
Practice Address - Country:US
Practice Address - Phone:231-777-2511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-24
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201009907225X00000X
UT10381965-4201225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist