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General NPI Number Information
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NPI Number | 1477063493
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Entity Type | Organization
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Legal Business Name | JANDK LASTINGER INC.
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Dates
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Enumeration Date | 10/04/2017
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Last Update Date | 10/04/2017
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Provider Practice Location Address
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Address Line | 5492 N SIERRA VISTA DR
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City | CRYSTAL RIVER
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State | FL
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Zip | 34428-6493
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Country | US
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Telephone | 352-219-7173
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2524
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City | CRYSTAL RIVER
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State | FL
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Zip | 34423-2524
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KARIN LASTINGER
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Credential |
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Telephone | 352-219-7173
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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 | OTR13654
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License Number State | FL
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