Provider Demographics
NPI:1114095825
Name:DILLON, LORI ANN (OTR LICENSED)
Entity Type:Individual
Prefix:MISS
First Name:LORI
Middle Name:ANN
Last Name:DILLON
Suffix:
Gender:F
Credentials:OTR LICENSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 N 82ND ST UNIT 1007
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-2770
Mailing Address - Country:US
Mailing Address - Phone:480-947-1679
Mailing Address - Fax:
Practice Address - Street 1:4200 N 82ND ST UNIT 1007
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-2770
Practice Address - Country:US
Practice Address - Phone:480-947-1679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1648225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ455312-02OtherAHCCCS NUMBER
AZ00350OtherDDD CONTRACT NUMBER
AZAZ0463220OtherBCBS PROVIDER ID