Provider Demographics
NPI:1235279837
Name:AITKEN, LARA MICHELLE (DOM)
Entity Type:Individual
Prefix:MS
First Name:LARA
Middle Name:MICHELLE
Last Name:AITKEN
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5298 COMMANDER DR
Mailing Address - Street 2:APT. 108
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-5304
Mailing Address - Country:US
Mailing Address - Phone:407-654-8700
Mailing Address - Fax:
Practice Address - Street 1:5298 COMMANDER DR
Practice Address - Street 2:APT. 108
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-5304
Practice Address - Country:US
Practice Address - Phone:407-654-8700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 2250171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist