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General NPI Number Information
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NPI Number | 1538371992
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Entity Type | Individual
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Provider Name | GERALD FRANCIS LACKAR OTR
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Gender | Male
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Dates
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Enumeration Date | 05/05/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 501 S BEACH BLVD
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City | ANAHEIM
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State | CA
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Zip | 92804-1810
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Country | US
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Telephone | 714-816-0540
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Fax |
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Provider Business Mailing Address
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Address Line | 141 W WILSHIRE AVE APT 311
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City | FULLERTON
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State | CA
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Zip | 92832-1840
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Country | US
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Telephone | 512-619-0184
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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 | 9350
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License Number State | CA
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