Provider Demographics
NPI:1609903749
Name:TOLAND, LORA CARROLL (OTR)
Entity Type:Individual
Prefix:MRS
First Name:LORA
Middle Name:CARROLL
Last Name:TOLAND
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 1:2722 COUNTY ROAD 102
Mailing Address - Street 2:
Mailing Address - City:EUREKA SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72632-9126
Mailing Address - Country:US
Mailing Address - Phone:619-940-9226
Mailing Address - Fax:
Practice Address - Street 1:5151 MURPHY CANYON RD
Practice Address - Street 2:SUITE 150
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-4440
Practice Address - Country:US
Practice Address - Phone:619-940-9226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1152225X00000X
CAOT10304225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR131406721Medicaid