Provider Demographics
NPI:1477829513
Name:CUSSON, LORI LEE
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:LEE
Last Name:CUSSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 VINTON RD
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01521-2452
Mailing Address - Country:US
Mailing Address - Phone:508-380-8363
Mailing Address - Fax:
Practice Address - Street 1:15 SOUTH ST
Practice Address - Street 2:SUITE B
Practice Address - City:HUDSON
Practice Address - State:MA
Practice Address - Zip Code:01749-2205
Practice Address - Country:US
Practice Address - Phone:978-562-6323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-22
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist