Provider Demographics
NPI:1811199482
Name:EHMANN, LORI KATHERINE (OTR)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:KATHERINE
Last Name:EHMANN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:
Other - Last Name:MICKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 OCEAN WAY DR
Mailing Address - Street 2:
Mailing Address - City:PONCE INLET
Mailing Address - State:FL
Mailing Address - Zip Code:32127-7321
Mailing Address - Country:US
Mailing Address - Phone:386-295-6561
Mailing Address - Fax:
Practice Address - Street 1:1104 BEVILLE RD
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-5797
Practice Address - Country:US
Practice Address - Phone:386-252-7837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT12383225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics