Provider Demographics
NPI:1326775586
Name:LANIER, WILLOW (COTA/L)
Entity Type:Individual
Prefix:
First Name:WILLOW
Middle Name:
Last Name:LANIER
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 1:11110 TOM ADAMS DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78753-3354
Mailing Address - Country:US
Mailing Address - Phone:844-960-4968
Mailing Address - Fax:
Practice Address - Street 1:11110 TOM ADAMS DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78753-3354
Practice Address - Country:US
Practice Address - Phone:844-960-4968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-06
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX217252224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant