MEDICARE: ETHEL LAI OTR/L

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
1	225X00000X	Occupational Therapist	OT9773	CA

General Provider Information

NPI Number	:	1477807493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ETHEL LAI OTR/L

Provider Business Mailing Address
First Line	:	5030 MAPLEWOOD AVE APT 205
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90004-2531
Country	:	US
Telephone Number	:	323-462-1030
Fax Number	:

Provider Business Practice Location Address
First Line	:	5030 MAPLEWOOD AVE APT 205
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90004-2531
Country	:	US
Telephone Number	:	323-462-1030
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/29/2012
Last Update Date	:	10/29/2012

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