Provider Demographics
NPI:1659441590
Name:STODDART, LORI JEAN (OTR)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:JEAN
Last Name:STODDART
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 1:1583 GRANGE RD
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48183-1737
Mailing Address - Country:US
Mailing Address - Phone:734-246-8963
Mailing Address - Fax:
Practice Address - Street 1:2333 BIDDLE AVENUE
Practice Address - Street 2:
Practice Address - City:WYANDOTTE
Practice Address - State:MI
Practice Address - Zip Code:48192-4693
Practice Address - Country:US
Practice Address - Phone:734-246-8963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201000090225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist