Provider Demographics
NPI:1417535618
Name:LARA, ANNMARIE NONE (COTA/L)
Entity Type:Individual
Prefix:MS
First Name:ANNMARIE
Middle Name:NONE
Last Name:LARA
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 1:16413 N 91ST ST BLDG C145
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-3056
Mailing Address - Country:US
Mailing Address - Phone:480-447-3262
Mailing Address - Fax:
Practice Address - Street 1:16413 N 91ST ST BLDG C145
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-3056
Practice Address - Country:US
Practice Address - Phone:480-447-3262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-30
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1910224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant