Provider Demographics
NPI:1831310952
Name:STRADER, LORI JOLENE (MAED)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:JOLENE
Last Name:STRADER
Suffix:
Gender:F
Credentials:MAED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:276C LAMB RD
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-8509
Mailing Address - Country:US
Mailing Address - Phone:270-821-5952
Mailing Address - Fax:270-821-0484
Practice Address - Street 1:276C LAMB RD
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431-8509
Practice Address - Country:US
Practice Address - Phone:270-821-5952
Practice Address - Fax:270-821-0484
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTEACHING CERTIFICATE222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY00676OtherFIRST STEPS PROVIDER #