Provider Demographics
NPI:1710655899
Name:LIZZA, MATTHEW T (OTR/L)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:T
Last Name:LIZZA
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27655 MIDDLEBELT RD STE 130
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-5029
Mailing Address - Country:US
Mailing Address - Phone:248-318-7912
Mailing Address - Fax:
Practice Address - Street 1:27655 MIDDLEBELT RD STE 130
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-5029
Practice Address - Country:US
Practice Address - Phone:248-318-7912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-02
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201011220225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist