Provider Demographics
NPI:1790926129
Name:HYDE, LORI ANN (OT)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:ANN
Last Name:HYDE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22524 TROMBLY ST
Mailing Address - Street 2:
Mailing Address - City:ST CLR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-2886
Mailing Address - Country:US
Mailing Address - Phone:586-778-3649
Mailing Address - Fax:
Practice Address - Street 1:35746 HARPER AVE
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48035-3212
Practice Address - Country:US
Practice Address - Phone:586-791-9203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-14
Last Update Date:2009-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201003121225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist