Provider Demographics
NPI:1669661419
Name:SOUZA, LORRAINE B (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:LORRAINE
Middle Name:B
Last Name:SOUZA
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 1:1 SHORT ST
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02048-3218
Mailing Address - Country:US
Mailing Address - Phone:508-339-7189
Mailing Address - Fax:
Practice Address - Street 1:444 WASHINGTON ST
Practice Address - Street 2:SUITE 506
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801
Practice Address - Country:US
Practice Address - Phone:866-937-9777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3723225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist