Provider Demographics
NPI:1598060725
Name:FOSTER, LORI
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:FOSTER
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 1:208 W LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:DIX
Mailing Address - State:IL
Mailing Address - Zip Code:62830-1469
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:208 W LINCOLN ST
Practice Address - Street 2:
Practice Address - City:DIX
Practice Address - State:IL
Practice Address - Zip Code:62830-1469
Practice Address - Country:US
Practice Address - Phone:773-227-2343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-19
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057.003324224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant