Provider Demographics
NPI:1902874423
Name:KOZDEN, LISA (MOT, OTR/L, CHT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:KOZDEN
Suffix:
Gender:F
Credentials:MOT, OTR/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1078 WYOMING AVE
Mailing Address - Street 2:# 175
Mailing Address - City:WYOMING
Mailing Address - State:PA
Mailing Address - Zip Code:18644-1331
Mailing Address - Country:US
Mailing Address - Phone:888-509-1328
Mailing Address - Fax:888-875-5883
Practice Address - Street 1:3 N RIVER ST
Practice Address - Street 2:UNIT 5
Practice Address - City:PLAINS
Practice Address - State:PA
Practice Address - Zip Code:18705-1334
Practice Address - Country:US
Practice Address - Phone:570-820-5900
Practice Address - Fax:888-875-5883
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC007257L225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand