Provider Demographics
NPI:1164184305
Name:OWEN, LORI A (OTT)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:A
Last Name:OWEN
Suffix:
Gender:F
Credentials:OTT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1239 E 31ST ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-2005
Mailing Address - Country:US
Mailing Address - Phone:405-314-9020
Mailing Address - Fax:
Practice Address - Street 1:1239 E 31ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-2005
Practice Address - Country:US
Practice Address - Phone:405-314-9020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1598225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist