Provider Demographics
NPI:1639298722
Name:PORCH, LORI LEANN (OTR)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:LEANN
Last Name:PORCH
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:LEANN
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:392 CLAYTONS WAY
Mailing Address - Street 2:
Mailing Address - City:METAMORA
Mailing Address - State:IL
Mailing Address - Zip Code:61548
Mailing Address - Country:US
Mailing Address - Phone:309-360-4228
Mailing Address - Fax:
Practice Address - Street 1:392 CLAYTONS WAY
Practice Address - Street 2:
Practice Address - City:METAMORA
Practice Address - State:IL
Practice Address - Zip Code:61548
Practice Address - Country:US
Practice Address - Phone:309-360-4228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics