Provider Demographics
NPI:1902654676
Name:HENSLEY, LARA LEE (COTA/L)
Entity Type:Individual
Prefix:MS
First Name:LARA
Middle Name:LEE
Last Name:HENSLEY
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:MS
Other - First Name:LARA
Other - Middle Name:LEE
Other - Last Name:LAKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18601 GARDEN RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012-8214
Mailing Address - Country:US
Mailing Address - Phone:405-590-7879
Mailing Address - Fax:
Practice Address - Street 1:307 E DANFORTH RD STE 130
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-4485
Practice Address - Country:US
Practice Address - Phone:405-397-3550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1226224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant