Provider Demographics
NPI:1750609723
Name:VANDOREN, LANA IKU (COTA)
Entity type:Individual
Prefix:MRS
First Name:LANA
Middle Name:IKU
Last Name:VANDOREN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13005 COMMUNITY CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33625-4000
Mailing Address - Country:US
Mailing Address - Phone:813-962-7138
Mailing Address - Fax:
Practice Address - Street 1:13005 COMMUNITY CAMPUS DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33625-4000
Practice Address - Country:US
Practice Address - Phone:813-962-7138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-14
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9695224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant