Provider Demographics
NPI:1023023371
Name:BOSSET, LORI ANN (OTR/L)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:ANN
Last Name:BOSSET
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:ANN
Other - Last Name:MACDONALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1200 LEXINGTON GREEN LN
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-1013
Mailing Address - Country:US
Mailing Address - Phone:386-226-4537
Mailing Address - Fax:407-322-3442
Practice Address - Street 1:290 CLYDE MORRIS BLVD STE A1
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174
Practice Address - Country:US
Practice Address - Phone:386-898-0443
Practice Address - Fax:386-898-0459
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT6537225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL892521600Medicaid
FLZ134DOtherBLUE CROSS BLUE SHIELD FL
FLZ134DOtherBLUE CROSS BLUE SHIELD FL