Provider Demographics
NPI:1356653620
Name:SHUGARS, LORI LYNN (OT)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:LYNN
Last Name:SHUGARS
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 1:1834 FIELDS BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46140-3029
Mailing Address - Country:US
Mailing Address - Phone:317-527-5437
Mailing Address - Fax:317-318-1356
Practice Address - Street 1:1834 FIELDS BLVD
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:IN
Practice Address - Zip Code:46140-3029
Practice Address - Country:US
Practice Address - Phone:317-527-5437
Practice Address - Fax:317-318-1356
Is Sole Proprietor?:No
Enumeration Date:2010-07-02
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31002757A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200988130Medicaid
IN100239270Medicaid