Provider Demographics
NPI:1932487311
Name:SCHICK, LORI ANN (COTA)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:ANN
Last Name:SCHICK
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:292 W PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE HELEN
Mailing Address - State:FL
Mailing Address - Zip Code:32744-2911
Mailing Address - Country:US
Mailing Address - Phone:386-228-9925
Mailing Address - Fax:
Practice Address - Street 1:292 W PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:LAKE HELEN
Practice Address - State:FL
Practice Address - Zip Code:32744-2911
Practice Address - Country:US
Practice Address - Phone:386-228-9925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-02
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOAT11813172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker