Provider Demographics
NPI:1497905319
Name:LUPOLI, LAURI ANN (OTR/L)
Entity Type:Individual
Prefix:
First Name:LAURI
Middle Name:ANN
Last Name:LUPOLI
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 CAPISTRANO DR
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32176-2105
Mailing Address - Country:US
Mailing Address - Phone:386-441-9333
Mailing Address - Fax:
Practice Address - Street 1:535 N NOVA RD
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-4405
Practice Address - Country:US
Practice Address - Phone:386-673-1809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-28
Last Update Date:2008-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT8938225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist