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General NPI Number Information
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NPI Number | 1093647885
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Entity Type | Individual
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Provider Name | TARA LAKES OT/L
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Gender | Female
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Dates
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Enumeration Date | 06/03/2026
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Last Update Date | 06/03/2026
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Provider Practice Location Address
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Address Line | 10049 E DYNAMITE BLVD STE 130
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City | SCOTTSDALE
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State | AZ
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Zip | 85262-3695
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Country | US
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Telephone | 480-419-0848
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Fax |
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Provider Business Mailing Address
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Address Line | 18126 W PUGET AVE
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City | WADDELL
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State | AZ
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Zip | 85355-7505
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Country | US
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Telephone | 317-985-1294
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | OTH-006632
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License Number State | AZ
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