Provider Demographics
NPI:1922132349
Name:FITZGERALD, LORI ANNE (OTRL)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:ANNE
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01887-2307
Mailing Address - Country:US
Mailing Address - Phone:617-306-6211
Mailing Address - Fax:
Practice Address - Street 1:80 DEACONESS RD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-4168
Practice Address - Country:US
Practice Address - Phone:978-402-8225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8229225X00000X
NH1862225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist