Provider Demographics
NPI:1013157783
Name:FULE, LANIE
Entity Type:Individual
Prefix:
First Name:LANIE
Middle Name:
Last Name:FULE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11526 HONEYGLEN RD
Mailing Address - Street 2:
Mailing Address - City:PACOIMA
Mailing Address - State:CA
Mailing Address - Zip Code:91331-1481
Mailing Address - Country:US
Mailing Address - Phone:818-458-0535
Mailing Address - Fax:
Practice Address - Street 1:8660 WOODLEY AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:NORTH HILLS
Practice Address - State:CA
Practice Address - Zip Code:91343-5745
Practice Address - Country:US
Practice Address - Phone:818-894-2273
Practice Address - Fax:818-827-4998
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-20
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 8094225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist