Provider Demographics
NPI:1821180332
Name:OTT, LORI LYNN (OT)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:LYNN
Last Name:OTT
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:LYNN
Other - Last Name:CUPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1901 PLACID RAVINE ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-5961
Mailing Address - Country:US
Mailing Address - Phone:949-275-2516
Mailing Address - Fax:
Practice Address - Street 1:4855 BLUE DIAMOND RD STE 210
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89139-7602
Practice Address - Country:US
Practice Address - Phone:725-207-3770
Practice Address - Fax:702-505-9020
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 2425225X00000X
NVOT-3052225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWOT2425AOtherMEDICAR PTAN