Provider Demographics
NPI:1225594138
Name:SERVATI, LORRIE (RBT)
Entity Type:Individual
Prefix:
First Name:LORRIE
Middle Name:
Last Name:SERVATI
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 E MEMORIAL RD STE C1
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73114-2218
Mailing Address - Country:US
Mailing Address - Phone:405-383-9001
Mailing Address - Fax:
Practice Address - Street 1:510 E MEMORIAL RD STE C1
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73114-2218
Practice Address - Country:US
Practice Address - Phone:405-383-9001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-15
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-18-59164247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
RBT-18-59164OtherBACB