Individual
TARA LAKES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT/L
Contact information
Practice address
10049 E DYNAMITE BLVD STE 130, SCOTTSDALE, AZ 85262-3695
(480) 419-0848
Mailing address
18126 W PUGET AVE, WADDELL, AZ 85355-7505
(317) 985-1294
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
OTH-006632
AZ
Other
Enumeration date
06/03/2026
Last updated
06/03/2026
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