Provider Demographics
NPI:1588012850
Name:LANG, FATIMA (OTR/L)
Entity Type:Individual
Prefix:
First Name:FATIMA
Middle Name:
Last Name:LANG
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 52422
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93031-2422
Mailing Address - Country:US
Mailing Address - Phone:805-218-1612
Mailing Address - Fax:
Practice Address - Street 1:1220 JOHNSON DR SPC 137
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-0507
Practice Address - Country:US
Practice Address - Phone:805-218-1612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-27
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT3573225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics