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General NPI Number Information
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NPI Number | 1851535413
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Entity Type | Individual
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Provider Name | MICHELLE LARA KIM O.T.R./L
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Gender | Female
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Dates
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Enumeration Date | 04/27/2009
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Last Update Date | 11/18/2021
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Provider Practice Location Address
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Address Line | 9161 SIERRA AVE SUITE 111
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City | FONTANA
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State | CA
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Zip | 92335-4729
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Country | US
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Telephone | 909-427-4073
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Fax |
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Provider Business Mailing Address
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Address Line | 26430 MARGARITA LN
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City | LOMA LINDA
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State | CA
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Zip | 92354-6741
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Country | US
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Telephone | 909-210-3892
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | OT 2282
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License Number State | CA
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