Basic Information
| Provider Information | |||||||||
| NPI: | 1942289012 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAMAR | ||||||||
| FirstName: | HEIDI | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1450 YAKUTAT RD | ||||||||
| Address2: | |||||||||
| City: | NORTH PORT | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342874178 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9414417217 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3938 S TAMIAMI TRL | ||||||||
| Address2: | |||||||||
| City: | SARASOTA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342313622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9413660011 | ||||||||
| FaxNumber: | 9419570033 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2006 | ||||||||
| LastUpdateDate: | 03/15/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | OT 6316 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | Z098G | 01 | BLUE CROSS BLUE SHIELD FL | OTHER |