Provider Demographics
NPI:1467893057
Name:GANZ, LORI J (OTR)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:J
Last Name:GANZ
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:A
Other - Last Name:JOHNSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:445 E CHEYENNE MOUNTAIN BLVD STE C
Mailing Address - Street 2:SUITE 331
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-4560
Mailing Address - Country:US
Mailing Address - Phone:719-651-1234
Mailing Address - Fax:
Practice Address - Street 1:445 E CHEYENNE MOUNTAIN BLVD STE C
Practice Address - Street 2:SUITE 331
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-4560
Practice Address - Country:US
Practice Address - Phone:719-651-1234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-10
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0000938225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics