Provider Demographics
NPI:1316217052
Name:DE LOURA, TONI (OTR/L)
Entity Type:Individual
Prefix:
First Name:TONI
Middle Name:
Last Name:DE LOURA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 HILLCREST CIR
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28792-3009
Mailing Address - Country:US
Mailing Address - Phone:828-713-0560
Mailing Address - Fax:
Practice Address - Street 1:4381 BELLS FERRY RD NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-1303
Practice Address - Country:US
Practice Address - Phone:724-816-1800
Practice Address - Fax:865-951-7273
Is Sole Proprietor?:No
Enumeration Date:2012-01-11
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT007258225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist