Provider Demographics
NPI:1427542802
Name:LARA, CARA MARIE (AT, ATC)
Entity type:Individual
Prefix:
First Name:CARA
Middle Name:MARIE
Last Name:LARA
Suffix:
Gender:
Credentials:AT, ATC
Other - Prefix:
Other - First Name:CARA
Other - Middle Name:
Other - Last Name:HARM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:33900 HARPER AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-4258
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1467 E 12 MILE RD
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-2653
Practice Address - Country:US
Practice Address - Phone:248-658-2110
Practice Address - Fax:248-658-2111
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-19
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI26010017642255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer