Provider Demographics
NPI:1972790970
Name:MEDEIROS, LORI-ANNE (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:LORI-ANNE
Middle Name:
Last Name:MEDEIROS
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 1:211 CORNELL STREET
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740-1713
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:92 GRAPE ST
Practice Address - Street 2:UNIT 1
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-2143
Practice Address - Country:US
Practice Address - Phone:508-991-2332
Practice Address - Fax:508-991-8437
Is Sole Proprietor?:No
Enumeration Date:2007-10-03
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2264225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1972790970OtherBMC HEALTHNET
MAOG0068OtherBLUE CROSS BLUE SHIELD
MAAA14788OtherHARVARD PILGRIM
MA0722472OtherMASSHEALTH
MA691582OtherTUFTS
MA1972790970OtherBMC HEALTHNET