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General NPI Number Information
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NPI Number | 1457816498
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Entity Type | Individual
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Provider Name | ALLANA JACLYN LUMBARD OTR/L
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Gender | Female
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Dates
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Enumeration Date | 02/04/2019
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Last Update Date | 05/12/2020
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Provider Practice Location Address
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Address Line | 1327 KALAKAKET ST
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City | FAIRBANKS
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State | AK
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Zip | 99709-4917
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Country | US
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Telephone | 757-284-5289
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Fax |
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Provider Business Mailing Address
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Address Line | 205 34TH ST APT 909
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City | VIRGINIA BEACH
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State | VA
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Zip | 23451-2800
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Country | US
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Telephone | 757-284-5289
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 0119007987
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License Number State | VA
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