Provider Demographics
NPI:1598927279
Name:TODD, LORELEI JACINTO (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:LORELEI
Middle Name:JACINTO
Last Name:TODD
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 1:220 NE SAN BAYO CIR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97365-2203
Mailing Address - Country:US
Mailing Address - Phone:541-264-0259
Mailing Address - Fax:
Practice Address - Street 1:835 SW 11TH ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365-4802
Practice Address - Country:US
Practice Address - Phone:541-265-5356
Practice Address - Fax:541-265-8905
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1003928225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist