Individual
ANITA ELLIOTT LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
3840 HULEN ST, FORT WORTH, TX 76107-7277
(817) 569-4396
Mailing address
PO BOX 2603, FORT WORTH, TX 76113-2603
(817) 569-4396
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
100842
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1902113798
CONTRACTOR
TX
Enumeration date
09/01/2010
Last updated
10/19/2010
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