Provider Demographics
NPI:1093050569
Name:BENDER COLLINSON, LORI ALETA (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:ALETA
Last Name:BENDER COLLINSON
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:PO BOX 200
Mailing Address - Street 2:
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-0200
Mailing Address - Country:US
Mailing Address - Phone:360-885-6200
Mailing Address - Fax:
Practice Address - Street 1:20601 NE 167TH AVE
Practice Address - Street 2:
Practice Address - City:BATTLE GROUND
Practice Address - State:WA
Practice Address - Zip Code:98604-3653
Practice Address - Country:US
Practice Address - Phone:360-885-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-10
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00004310225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist