Provider Demographics
NPI:1700945680
Name:WEGER, LARK ANN (OTRL)
Entity type:Individual
Prefix:MS
First Name:LARK
Middle Name:ANN
Last Name:WEGER
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:LARK
Other - Middle Name:ANN
Other - Last Name:WEGER FAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1781
Mailing Address - Street 2:
Mailing Address - City:LOOMIS
Mailing Address - State:CA
Mailing Address - Zip Code:95650
Mailing Address - Country:US
Mailing Address - Phone:916-652-7404
Mailing Address - Fax:
Practice Address - Street 1:1040 MARSHALL WAY
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:85667
Practice Address - Country:US
Practice Address - Phone:530-622-3400
Practice Address - Fax:530-622-3407
Is Sole Proprietor?:No
Enumeration Date:2006-12-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT4866225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist