Individual
DAVID LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COTA/L,MHA
Contact information
Practice address
19 BRIARMIST CT, O FALLON, MO 63366-6318
(636) 379-4441
Mailing address
19 BRIARMIST CT, O FALLON, MO 63366-6318
(636) 379-4441
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2000157289
MO
Other
Enumeration date
08/14/2007
Last updated
08/14/2007
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