Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Olivia Lake

Individual provider Other Specialist/Technologist · NPI 1073289955

Olivia Lake is an Other Specialist/Technologist in Fort Worth, Texas. Registered with an NPI since 2021.

In the registry since
2021

Practice location Address checks out

111 Boland St # 210
Fort Worth, TX 76107-1263
Phone: (817) 529-8485
Fax: (469) 453-5075
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Other Specialist/Technologist (primary) Taxonomy 246Z00000X

Record details

NPI number1073289955
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedAugust 19, 2021
Last updated in NPPESAugust 19, 2021
Certification dateAugust 19, 2021
Mailing address111 Boland St # 210, Fort Worth, TX 76107-1263

Other providers in Fort Worth