Provider Demographics
NPI:1689176828
Name:STANEK, LANE ELIZABETH (COTA)
Entity Type:Individual
Prefix:
First Name:LANE
Middle Name:ELIZABETH
Last Name:STANEK
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20677 SR 124
Mailing Address - Street 2:
Mailing Address - City:ATKINS
Mailing Address - State:AR
Mailing Address - Zip Code:72823-8196
Mailing Address - Country:US
Mailing Address - Phone:479-518-8113
Mailing Address - Fax:
Practice Address - Street 1:104 E BOWER AVE
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-3610
Practice Address - Country:US
Practice Address - Phone:479-426-1214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-04
Last Update Date:2018-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant