Provider Demographics
NPI:1598004004
Name:HART, LORRIE ANN (COTA)
Entity Type:Individual
Prefix:MRS
First Name:LORRIE
Middle Name:ANN
Last Name:HART
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5201 FOUNTAIN DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-5324
Mailing Address - Country:US
Mailing Address - Phone:219-796-9335
Mailing Address - Fax:
Practice Address - Street 1:5201 FOUNTAIN DR
Practice Address - Street 2:SUITE D
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-5324
Practice Address - Country:US
Practice Address - Phone:219-796-9335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-04
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057.003693224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant