Provider Demographics
NPI:1043588445
Name:WOLFE, LORI I (OTR)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:I
Last Name:WOLFE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1287
Mailing Address - Street 2:
Mailing Address - City:MONTAUK
Mailing Address - State:NY
Mailing Address - Zip Code:11954-0896
Mailing Address - Country:US
Mailing Address - Phone:516-384-8556
Mailing Address - Fax:
Practice Address - Street 1:55 NORTH FARRAGUT ROAD
Practice Address - Street 2:
Practice Address - City:MONTAUK
Practice Address - State:NY
Practice Address - Zip Code:11954
Practice Address - Country:US
Practice Address - Phone:516-384-8556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013056-1225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics