Provider Demographics
NPI:1629145917
Name:LISA E. CYZNER, PHD, OTRL
Entity Type:Organization
Organization Name:LISA E. CYZNER, PHD, OTRL
Other - Org Name:PRIVATE PRACTICE OF LISA E. CYZNER, PHD, OTRL
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER AND DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:CYZNER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD OTRL
Authorized Official - Phone:704-542-9473
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4095225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7212092Medicaid