Provider Demographics
NPI:1205050051
Name:L. A. MICHAELS AND ASSOCIATES, A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:L. A. MICHAELS AND ASSOCIATES, A PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MICHAELS
Authorized Official - Suffix:
Authorized Official - Credentials:OTR L
Authorized Official - Phone:209-339-1690
Mailing Address - Street 1:525 S FAIRMONT AVE
Mailing Address - Street 2:SUITE G
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95240-3860
Mailing Address - Country:US
Mailing Address - Phone:209-339-1690
Mailing Address - Fax:209-339-1693
Practice Address - Street 1:525 S FAIRMONT AVE
Practice Address - Street 2:SUITE G
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-3860
Practice Address - Country:US
Practice Address - Phone:209-339-1690
Practice Address - Fax:209-339-1693
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:L.A. MICHAELS & ASSOCIATES, A PROFESSIONAL CORPORTATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-12
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 3033225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty