# SKY LAKES MEDICAL CENTER INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134270911
- **Authorized official:** MR. RICHARD E RICO (VP)
- **Authorized official phone:** (541) 274-6150

## Contact information

- **Practice address:** 2621 CROSBY AVE, KLAMATH FALLS, OR 97603-5726
- **Practice address phone:** (541) 274-6406
- **Practice address fax:** (541) 274-6711
- **Mailing address:** 2865 DAGGETT AVE, KLAMATH FALLS, OR 97601-1106
- **Mailing address phone:** (541) 274-6221
- **Mailing address fax:** (541) 274-6247

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225X00000X | Occupational Therapist | 0700001687 | OR | Yes |

## Other

- **Enumeration date:** 01/16/2007
- **Last updated:** 11/10/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 152371 | — | OR |
| 05 | — | ZZR20101F | — | OR |