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NPI Code Detail

MEDICARE: LARA HEALY OTR

MEDICARE: LARA HEALY OTR
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist056014520IL

General Provider Information

NPI Number : 1033880653
Entity Type Code : Individual
Provider Name (Legal Business Name) : LARA HEALY OTR
Provider Business Mailing Address
First Line : 575 MALLARD LN
Second Line :
City : MASON
State : IL
Zip : 62443-3612
Country : US
Telephone Number : 812-430-8979
Fax Number :
Provider Business Practice Location Address
First Line : 701 SHADWELL AVE
Second Line :
City : FLORA
State : IL
Zip : 62839-2310
Country : US
Telephone Number : 618-662-8361
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/23/2021
Last Update Date : 10/14/2021

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