Provider Demographics
NPI:1417578337
Name:GOLDSBOROUGH, LORI H (OTR)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:H
Last Name:GOLDSBOROUGH
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 1:7055 BOGGS SCHOOLHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:WESTOVER
Mailing Address - State:MD
Mailing Address - Zip Code:21871-3739
Mailing Address - Country:US
Mailing Address - Phone:410-726-5641
Mailing Address - Fax:
Practice Address - Street 1:201 HALL HWY
Practice Address - Street 2:
Practice Address - City:CRISFIELD
Practice Address - State:MD
Practice Address - Zip Code:21817-1237
Practice Address - Country:US
Practice Address - Phone:410-968-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-01
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01934225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist