Provider Demographics
NPI:1982733416
Name:LAZARO, MICHELLE ROSE (OTRL)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ROSE
Last Name:LAZARO
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5702 VICTOR ST APT 5
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-4737
Mailing Address - Country:US
Mailing Address - Phone:517-402-1110
Mailing Address - Fax:
Practice Address - Street 1:291 S LA CIENEGA BLVD
Practice Address - Street 2:SUITE 409
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-3325
Practice Address - Country:US
Practice Address - Phone:310-289-1157
Practice Address - Fax:310-289-1158
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7408225XP0200X
TX115039225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics