Provider Demographics
NPI:1437128535
Name:PETERSON, LORI A (OTR/L, CHT)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:A
Last Name:PETERSON
Suffix:
Gender:F
Credentials:OTR/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1661 SAINT ANTHONY AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-3733
Mailing Address - Country:US
Mailing Address - Phone:651-842-5200
Mailing Address - Fax:
Practice Address - Street 1:310 SMITH AVE N STE 370
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2383
Practice Address - Country:US
Practice Address - Phone:651-223-5406
Practice Address - Fax:651-287-3777
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN101347225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand