Provider Demographics
NPI:1083992879
Name:BASS, LORI ANN
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:ANN
Last Name:BASS
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 1:265 N CURRANT ST
Mailing Address - Street 2:
Mailing Address - City:PINEBLUFF
Mailing Address - State:NC
Mailing Address - Zip Code:28373-8109
Mailing Address - Country:US
Mailing Address - Phone:910-783-4835
Mailing Address - Fax:
Practice Address - Street 1:265 N CURRANT ST
Practice Address - Street 2:
Practice Address - City:PINEBLUFF
Practice Address - State:NC
Practice Address - Zip Code:28373-8109
Practice Address - Country:US
Practice Address - Phone:910-783-4835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-27
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist