Basic Information
| Provider Information | |||||||||
| NPI: | 1205021615 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LIZAKOWSKI | ||||||||
| FirstName: | LYNN | ||||||||
| MiddleName: | M. SULANDER | ||||||||
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| Credential: | C.O.T.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 709 BALLANTYNE LN NE | ||||||||
| Address2: | |||||||||
| City: | SPRING LAKE PARK | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554321957 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7637920498 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7540 N 19TH AVE | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850217967 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8888734221 | ||||||||
| FaxNumber: | 8885432289 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/09/2007 | ||||||||
| LastUpdateDate: | 09/09/2007 | ||||||||
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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 | 224Z00000X | 201263 | MN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.