Basic Information
| Provider Information | |||||||||
| NPI: | 1083704092 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PAWLYSZYN | ||||||||
| FirstName: | LYDIA | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | OTR/L, CHT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10165 LYNN DR | ||||||||
| Address2: | |||||||||
| City: | N ROYALTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441331425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4405824362 | ||||||||
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| Practice Location | |||||||||
| Address1: | 18697 BAGLEY RD | ||||||||
| Address2: | |||||||||
| City: | MIDDLEBURG HEIGHTS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441303417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4408168000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2006 | ||||||||
| LastUpdateDate: | 11/28/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225XH1200X | 000937 | OH | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Hand |
ID Information
| ID | Type | State | Issuer | Description | 0842995 | 05 | OH | MEDICAID | 000000217474 | 01 | OH | ANTHEM BLUE CROSS AND BLU | OTHER | OH4655A | 01 | BEECH STREET CORPORATION | OTHER |