Provider Demographics
NPI:1487780953
Name:LISHOK, CHRISTINE (MS OTRL)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:LISHOK
Suffix:
Gender:F
Credentials:MS OTRL
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:
Other - Last Name:SODAK, MAJOR, ARGUST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:RR 2 BOX 2295
Mailing Address - Street 2:
Mailing Address - City:FACTORYVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18419-9628
Mailing Address - Country:US
Mailing Address - Phone:570-222-5687
Mailing Address - Fax:
Practice Address - Street 1:1068 MARSHBROOK RD
Practice Address - Street 2:
Practice Address - City:FACTORYVILLE
Practice Address - State:PA
Practice Address - Zip Code:18419-9608
Practice Address - Country:US
Practice Address - Phone:570-510-0516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0138991225XP0200X
PAOC009944225XP0200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics