Provider Demographics
NPI:1831564459
Name:CISZEK, REBECCA (MOTR/L)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:CISZEK
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:192 BYRON RD
Mailing Address - Street 2:
Mailing Address - City:GERRARDSTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:25420-4594
Mailing Address - Country:US
Mailing Address - Phone:708-275-4752
Mailing Address - Fax:
Practice Address - Street 1:192 BYRON RD
Practice Address - Street 2:
Practice Address - City:GERRARDSTOWN
Practice Address - State:WV
Practice Address - Zip Code:25420-4594
Practice Address - Country:US
Practice Address - Phone:708-275-4752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-08
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1784225X00000X
VA0119006509225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1784OtherLISCENCE OF OT
VA011900659OtherLICENSE OF OCCUPATIONAL THERAPY