Provider Demographics
NPI:1457676603
Name:NORMAN, LORA JEAN (OTR/L CHT)
Entity Type:Individual
Prefix:
First Name:LORA
Middle Name:JEAN
Last Name:NORMAN
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 1:11406 BETSWORTH RD
Mailing Address - Street 2:
Mailing Address - City:VALLEY CENTER
Mailing Address - State:CA
Mailing Address - Zip Code:92082-6301
Mailing Address - Country:US
Mailing Address - Phone:760-749-9818
Mailing Address - Fax:
Practice Address - Street 1:16950 VIA TAZON
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92127-1607
Practice Address - Country:US
Practice Address - Phone:858-521-2025
Practice Address - Fax:858-521-7079
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-31
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 4025174400000X
CA1039152174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist