Provider Demographics
NPI:1487266821
Name:LAKIC, VICTORIA ROSE (MSOT, OTR/L)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:ROSE
Last Name:LAKIC
Suffix:
Gender:F
Credentials:MSOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 BEACON HILL LN
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-6668
Mailing Address - Country:US
Mailing Address - Phone:203-540-9157
Mailing Address - Fax:203-540-9157
Practice Address - Street 1:680 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-2684
Practice Address - Country:US
Practice Address - Phone:203-783-1997
Practice Address - Fax:203-783-3997
Is Sole Proprietor?:No
Enumeration Date:2020-08-18
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004736225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist