Individual provider · Type 1 NPI

Olivia Lake

Other Specialist/Technologist · Fort Worth, TX

NPI number 1073289955 Active

Practice location

111 Boland St # 210
Fort Worth, TX 76107-1263

Call (817) 529-8485 Map

Fax (469) 453-5075

Specialties and licenses

TaxonomyCodeLicense
Other Specialist/Technologist Primary 246Z00000XNone listed

Other Specialist/Technologist: General classification identifying individuals trained on specific equipment and technical procedures in one of a collection of miscellaneous healthcare disciplines.

2 other providers at this address

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About NPI 1073289955

Olivia Lake's National Provider Identifier is 1073289955, issued on Aug 19, 2021. The primary taxonomy on file is Other Specialist/Technologist (246Z00000X), and the practice location is in Fort Worth, TX. The record was last updated on Aug 19, 2021.