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General NPI Number Information
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NPI Number | 1700945680
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Entity Type | Individual
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Provider Name | LARK ANN WEGER OTRL
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Gender | Female
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Dates
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Enumeration Date | 12/07/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1040 MARSHALL WAY
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City | PLACERVILLE
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State | CA
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Zip | 85667
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Country | US
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Telephone | 530-622-3400
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Fax | 530-622-3407
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Provider Business Mailing Address
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Address Line | PO BOX 1781
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City | LOOMIS
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State | CA
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Zip | 95650
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Country | US
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Telephone | 916-652-7404
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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 | OT4866
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License Number State | CA
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