Provider Demographics
NPI:1972625689
Name:MACLEOD, LORI ELLEN (OTR)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:ELLEN
Last Name:MACLEOD
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 VICTORY RD
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:NY
Mailing Address - Zip Code:10901-3718
Mailing Address - Country:US
Mailing Address - Phone:845-357-0701
Mailing Address - Fax:
Practice Address - Street 1:51-55 NORTH ROUTE 9W
Practice Address - Street 2:
Practice Address - City:W. HAVERSTRAW
Practice Address - State:NY
Practice Address - Zip Code:10993
Practice Address - Country:US
Practice Address - Phone:845-786-4460
Practice Address - Fax:845-786-4022
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001769-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist