Healthcare Provider Details

I. General information

NPI: 1144438581
Provider Name (Legal Business Name): JULIE ANN LAKE OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4353 TULLER RD STE D
DUBLIN OH
43017-5071
US

IV. Provider business mailing address

5055 LANGCROFT DR
HILLIARD OH
43026-7159
US

V. Phone/Fax

Practice location:
  • Phone: 614-764-7900
  • Fax:
Mailing address:
  • Phone: 614-777-1618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number004535
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: