Provider Demographics
NPI:1699084335
Name:LANE, NATOSHA (OTR/L)
Entity type:Individual
Prefix:
First Name:NATOSHA
Middle Name:
Last Name:LANE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18979 REDLAND RD
Mailing Address - Street 2:APT 11202
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78259-3688
Mailing Address - Country:US
Mailing Address - Phone:816-830-9120
Mailing Address - Fax:
Practice Address - Street 1:13333 BLANCO RD
Practice Address - Street 2:STE 302
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-2138
Practice Address - Country:US
Practice Address - Phone:210-764-1188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-29
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113615225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist