Provider Demographics
NPI:1962670422
Name:FROST, LORI (OTR/L)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:FROST
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1090 WYNBROOKE PL
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:GA
Mailing Address - Zip Code:30650-4131
Mailing Address - Country:US
Mailing Address - Phone:706-474-1707
Mailing Address - Fax:
Practice Address - Street 1:1090 WYNBROOKE PL
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:GA
Practice Address - Zip Code:30650-4131
Practice Address - Country:US
Practice Address - Phone:706-474-1707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-18
Last Update Date:2008-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT001481225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist