Active NPI
Carmen Lysaker
- Occupational Therapist
- Fort Sam Houston, TX
National Provider Identifier
1073403820
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 124077
- Practice address
- 3551 Roger Brooke Dr
Fort Sam Houston, TX 78234-4504 - Phone
- (210) 916-7500
- NPI assigned
- Jul 3, 2025
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 124077 | TX | Primary |
Addresses
Primary practice location
3551 Roger Brooke Dr
Fort Sam Houston, TX 78234-4504
Mailing address
22800 Bulverde Rd Apt 502
San Antonio, TX 78261-3038
Phone (443) 846-3275
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 124077 | TX | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1751500800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1751500800000",
"number": "1073403820",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "22800 BULVERDE RD APT 502",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782613038",
"telephone_number": "443-846-3275"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3551 ROGER BROOKE DR",
"city": "FORT SAM HOUSTON",
"state": "TX",
"postal_code": "782344504",
"telephone_number": "210-916-7500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LYSAKER",
"first_name": "CARMEN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-07-03",
"last_updated": "2025-07-03",
"certification_date": "2025-07-03",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "TX",
"license": "124077",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Sam Houston, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.