Provider Demographics
NPI:1821170713
Name:MIZANY, SHEREEN (OTR / L, MOT)
Entity Type:Individual
Prefix:MS
First Name:SHEREEN
Middle Name:
Last Name:MIZANY
Suffix:
Gender:F
Credentials:OTR / L, MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1293
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93438-1293
Mailing Address - Country:US
Mailing Address - Phone:818-212-8148
Mailing Address - Fax:
Practice Address - Street 1:330 S K ST # B
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-7230
Practice Address - Country:US
Practice Address - Phone:805-735-7291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3567 THERAPY SERVICE174400000X
CA3567 O.T251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered174400000XOther Service ProvidersSpecialist
Not Answered251C00000XAgenciesDay Training, Developmentally Disabled Services