Provider Demographics
NPI:1346751252
Name:LORREN-JACKSON, HEIDI CLAIRE (OTR)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:CLAIRE
Last Name:LORREN-JACKSON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24519 REDLANDS BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-4000
Mailing Address - Country:US
Mailing Address - Phone:909-799-0078
Mailing Address - Fax:
Practice Address - Street 1:24519 REDLANDS BLVD STE B
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-4000
Practice Address - Country:US
Practice Address - Phone:909-799-0078
Practice Address - Fax:909-799-0078
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-18
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand