Provider Demographics
NPI:1316016363
Name:MANLEY, LORI ABBOTT (OT)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:ABBOTT
Last Name:MANLEY
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:993 FULLER RD
Mailing Address - Street 2:
Mailing Address - City:MARTIN
Mailing Address - State:TN
Mailing Address - Zip Code:38237-5125
Mailing Address - Country:US
Mailing Address - Phone:731-587-9476
Mailing Address - Fax:
Practice Address - Street 1:180 MOUNT PELIA RD
Practice Address - Street 2:
Practice Address - City:MARTIN
Practice Address - State:TN
Practice Address - Zip Code:38237-3812
Practice Address - Country:US
Practice Address - Phone:731-587-4231
Practice Address - Fax:731-587-0866
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN291225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist