Provider Demographics
NPI:1679712178
Name:KAISER, LORI P (OTR)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:P
Last Name:KAISER
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 1:2949 WOODBURY ST
Mailing Address - Street 2:
Mailing Address - City:COMMERCE TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48390-1479
Mailing Address - Country:US
Mailing Address - Phone:248-767-9577
Mailing Address - Fax:313-538-0938
Practice Address - Street 1:2949 WOODBURY ST
Practice Address - Street 2:
Practice Address - City:COMMERCE TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48390-1479
Practice Address - Country:US
Practice Address - Phone:248-767-9577
Practice Address - Fax:313-538-0938
Is Sole Proprietor?:No
Enumeration Date:2009-02-07
Last Update Date:2009-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201006069225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist