Provider Demographics
NPI:1043655947
Name:OVITZ, LORI MARLENE
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:MARLENE
Last Name:OVITZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 S PRAIRIE AVE APT 2301
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-3654
Mailing Address - Country:US
Mailing Address - Phone:312-420-5610
Mailing Address - Fax:
Practice Address - Street 1:1211 S PRAIRIE AVE APT 2301
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-3654
Practice Address - Country:US
Practice Address - Phone:312-420-5610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-06
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL247200000X247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other