Provider Demographics
NPI:1033562376
Name:LAKTASH, STEPHENIE (COTA/L)
Entity Type:Individual
Prefix:
First Name:STEPHENIE
Middle Name:
Last Name:LAKTASH
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15454 GALE AVE
Mailing Address - Street 2:SUITE F
Mailing Address - City:HACIENDA HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91745-1500
Mailing Address - Country:US
Mailing Address - Phone:626-330-1538
Mailing Address - Fax:626-239-1868
Practice Address - Street 1:15454 GALE AVE
Practice Address - Street 2:SUITE F
Practice Address - City:HACIENDA HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91745-1500
Practice Address - Country:US
Practice Address - Phone:626-330-1538
Practice Address - Fax:626-239-1868
Is Sole Proprietor?:No
Enumeration Date:2016-07-22
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant