Provider Demographics
NPI:1194011023
Name:SUAREZ, LORNA M (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:LORNA
Middle Name:M
Last Name:SUAREZ
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:MS
Other - First Name:LORNA
Other - Middle Name:M
Other - Last Name:SUAREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:257 KINGS POND AVE
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-1926
Mailing Address - Country:US
Mailing Address - Phone:863-398-1092
Mailing Address - Fax:
Practice Address - Street 1:257 KINGS POND AVE
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-1926
Practice Address - Country:US
Practice Address - Phone:863-398-1092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-20
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA9622224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant