Provider Demographics
NPI:1619475407
Name:HENDRICKS, LORI ELLYN (OTR/L)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:ELLYN
Last Name:HENDRICKS
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 1:4342 S GULF CIR
Mailing Address - Street 2:
Mailing Address - City:N FT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33903-5046
Mailing Address - Country:US
Mailing Address - Phone:352-895-2003
Mailing Address - Fax:
Practice Address - Street 1:991 PONDELLA RD STE 3103
Practice Address - Street 2:ATTN: REHAB DEPT
Practice Address - City:NORTH FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33903-3500
Practice Address - Country:US
Practice Address - Phone:239-995-8809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-26
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT10295225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist