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OLIVIA LAKE
NPI 1073289955
Specialist/Technologist, Other in Fort Worth, TX

Active since August 19, 2021
111 BOLAND ST # 210, FORT WORTH, TX 76107(817) 529-8485(469) 453-5075 Get Directions Write a Review

NPPES record last updated: August 19, 2021. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Olivia Lake NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

OLIVIA LAKE (NPI 1073289955) is an individual specialist/technologist, other provider in Fort Worth, Texas and active in the NPI registry since August 2021.

NPPES Registry Identity

NPI1073289955
Entity TypeIndividualFemale
Primary Taxonomy246Z00000X
Provider Legal NameOLIVIA LAKE
Location Address111 BOLAND ST # 210Fort Worth, TX 76107-1263
Mailing Address111 Boland St # 210Fort Worth, TX 76107-1263 · (817) 529-8485 · Fax (469) 453-5075
Phone(817) 529-8485
Fax(469) 453-5075
Sole ProprietorNo
Enumeration DateAugust 19, 2021
NPPES CertifiedAugust 19, 2021
✔ NPI 1073289955 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialist/Technologist, OtherTechnologists, Technicians & Other Technical Service Providers
Taxonomy Code246Z00000X
Definition
General classification identifying individuals trained on specific equipment and technical procedures in one of a collection of miscellaneous healthcare disciplines.
111 BOLAND ST # 210, Fort Worth, TX 76107
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Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

AARON J ALTERMAN
Specialist/Technologist, Other
111 BOLAND ST # 210
FORT WORTH, TX 76107
Tarrant County (817) 529-8485
SHANNON SALLEY
Specialist/Technologist, Other
111 BOLAND ST # 210
FORT WORTH, TX 76107
Tarrant County (817) 529-8514

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Olivia Lake's NPI number?

The NPI number for Olivia Lake is 1073289955. It was assigned to this individual provider in the NPPES registry on August 19, 2021.

Where is Olivia Lake located?

Olivia Lake practices at 111 Boland St # 210, Fort Worth, TX 76107. The listed phone number is (817) 529-8485.

What is Olivia Lake's specialty?

The primary specialty registered for this NPI is Specialist/Technologist, Other with taxonomy code 246Z00000X.

When was this NPI record last updated?

The NPPES record for Olivia Lake was last updated on August 19, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.