Provider Demographics
NPI:1760990972
Name:WOLF, LORI KAYE (OTR/L CHT)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:KAYE
Last Name:WOLF
Suffix:
Gender:F
Credentials:OTR/L CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11033 N 75TH DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85345-5983
Mailing Address - Country:US
Mailing Address - Phone:623-330-1833
Mailing Address - Fax:
Practice Address - Street 1:5605 W EUGIE AVE STE 215
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85304-1275
Practice Address - Country:US
Practice Address - Phone:602-865-5832
Practice Address - Fax:602-865-5857
Is Sole Proprietor?:No
Enumeration Date:2018-01-22
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0442225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand