MEDICARE: NATOSHA LANE 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	113615	TX

General Provider Information

NPI Number	:	1699084335
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATOSHA LANE OTR/L

Provider Business Mailing Address
First Line	:	18979 REDLAND RD
Second Line	:	APT 11202
City	:	SAN ANTONIO
State	:	TX
Zip	:	78259-3688
Country	:	US
Telephone Number	:	816-830-9120
Fax Number	:

Provider Business Practice Location Address
First Line	:	13333 BLANCO RD
Second Line	:	STE 302
City	:	SAN ANTONIO
State	:	TX
Zip	:	78216-2138
Country	:	US
Telephone Number	:	210-764-1188
Fax Number	:

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

Provider Enumeration Date	:	09/29/2010
Last Update Date	:	09/29/2010

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Directions to “ NATOSHA LANE OTR/L” Practice Location

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