Individual
MICHAEL HENRY LAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1 DAVID BRAINERD DR, MONROE TOWNSHIP, NJ 08831-1927
(732) 521-6400
Mailing address
2403 CYPRESS LN, EAST BRUNSWICK, NJ 08816-5274
(908) 240-9242
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
46TR00695100
NJ
Other
Enumeration date
07/28/2016
Last updated
07/28/2016
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