Provider Demographics
NPI:1598081036
Name:CARLSON, LORI ANN (OTR)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:ANN
Last Name:CARLSON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 AVENIDA MIROLA
Mailing Address - Street 2:
Mailing Address - City:PALOS VERDES ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274-4307
Mailing Address - Country:US
Mailing Address - Phone:310-544-6570
Mailing Address - Fax:866-593-1233
Practice Address - Street 1:701 AVENIDA MIROLA
Practice Address - Street 2:
Practice Address - City:PALOS VERDES ESTATES
Practice Address - State:CA
Practice Address - Zip Code:90274-4307
Practice Address - Country:US
Practice Address - Phone:310-544-6570
Practice Address - Fax:866-593-1233
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-08
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 00007642225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist