Provider Demographics
NPI:1992021794
Name:FUTRELL, LANE (COTA)
Entity Type:Individual
Prefix:
First Name:LANE
Middle Name:
Last Name:FUTRELL
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 1:753 E 360 S
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84097-6404
Mailing Address - Country:US
Mailing Address - Phone:801-400-5128
Mailing Address - Fax:
Practice Address - Street 1:753 E 360 S
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84097-6404
Practice Address - Country:US
Practice Address - Phone:801-400-5128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-19
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant