Provider Demographics
NPI:1679737118
Name:HENRY, LAWRENCE ALLEN (OTR/L)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:ALLEN
Last Name:HENRY
Suffix:
Gender:M
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 1:11308 28TH STREET CIR E
Mailing Address - Street 2:
Mailing Address - City:PARRISH
Mailing Address - State:FL
Mailing Address - Zip Code:34219-8983
Mailing Address - Country:US
Mailing Address - Phone:941-776-3980
Mailing Address - Fax:
Practice Address - Street 1:11308 28TH STREET CIR E
Practice Address - Street 2:
Practice Address - City:PARRISH
Practice Address - State:FL
Practice Address - Zip Code:34219-8983
Practice Address - Country:US
Practice Address - Phone:941-776-3980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-14
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0001175225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist