Sally Nelson Lysne, OTR

Individual provider Active NPI Occupational Therapist · Sparta, WI

NPI 1922083385 · NPPES record last updated Jul 13, 2026

Key facts

NPI
1922083385
Entity type
Individual (NPI type 1)
Primary specialty
Occupational Therapist 225X00000X
License
2826 (WI)
Practice address
310 W Main St
Sparta, WI 54656-2170
Phone
(608) 269-2132
Fax
(608) 269-8110
NPI assigned
Dec 8, 2005
Sex
Female
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
Yes

State licenses

LicenseStateTypeSpecialty
2826WIMDOptometrist

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 2826 WI Yes

Addresses

Primary practice location

310 W Main St
Sparta, WI 54656-2170

Mailing address

700 West Ave S
Attn Physician Services
La Crosse, WI 54601-4783
Phone (608) 791-4156

Other providers in Sparta, WI

All providers in Sparta, WI · Occupational Therapist in Wisconsin

Sources for this page

Verify at the official NPI Registry.