Provider Demographics
NPI:1730679531
Name:ZACK, LORI
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:ZACK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4834 LEHRER DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-1360
Mailing Address - Country:US
Mailing Address - Phone:858-775-7630
Mailing Address - Fax:
Practice Address - Street 1:4834 LEHRER DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-1360
Practice Address - Country:US
Practice Address - Phone:858-775-7630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-16
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OT3225OtherCALIFORNIA BOARD OF OCCUPATIONAL THERAPY