Provider Demographics
NPI:1952850141
Name:MISKE, LISA (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:MISKE
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 CRANBROOK CT
Mailing Address - Street 2:
Mailing Address - City:CENTERPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11721-1769
Mailing Address - Country:US
Mailing Address - Phone:631-902-5597
Mailing Address - Fax:
Practice Address - Street 1:27 CRANBROOK CT
Practice Address - Street 2:
Practice Address - City:CENTERPORT
Practice Address - State:NY
Practice Address - Zip Code:11721-1769
Practice Address - Country:US
Practice Address - Phone:631-902-5597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-28
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008781-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist