Provider Demographics
NPI:1760703458
Name:DESANDO, LORI ANN (OTR/L)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:ANN
Last Name:DESANDO
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 1:10 MILLENIUM ST
Mailing Address - Street 2:
Mailing Address - City:DUNMORE
Mailing Address - State:PA
Mailing Address - Zip Code:18512-2154
Mailing Address - Country:US
Mailing Address - Phone:570-346-6193
Mailing Address - Fax:
Practice Address - Street 1:10 MILLENIUM DR
Practice Address - Street 2:
Practice Address - City:DUNMORE
Practice Address - State:PA
Practice Address - Zip Code:18512-2154
Practice Address - Country:US
Practice Address - Phone:570-346-6193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-16
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC006768L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAOC006768LOtherSTATE OT LICENSE - PA