Provider Demographics
NPI:1033542295
Name:RIBAUDO, LORI DIANE (OTR/L)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:DIANE
Last Name:RIBAUDO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2114 N 127TH ST E
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-3003
Mailing Address - Country:US
Mailing Address - Phone:316-500-8800
Mailing Address - Fax:316-500-8818
Practice Address - Street 1:2114 N 127TH ST E
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-3003
Practice Address - Country:US
Practice Address - Phone:316-500-8800
Practice Address - Fax:316-500-8818
Is Sole Proprietor?:No
Enumeration Date:2013-08-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1702730225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist