Provider Demographics
NPI:1508009598
Name:WETZEL, LORI MARIE
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:MARIE
Last Name:WETZEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:MARIE
Other - Last Name:HAVRILAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:638 BRANDYWINE PKWY
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-4278
Mailing Address - Country:US
Mailing Address - Phone:610-436-3600
Mailing Address - Fax:610-436-3606
Practice Address - Street 1:638 BRANDYWINE PKWY
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-4278
Practice Address - Country:US
Practice Address - Phone:610-436-3600
Practice Address - Fax:610-436-3606
Is Sole Proprietor?:No
Enumeration Date:2009-04-07
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC010885225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist