Provider Demographics
NPI:1992846208
Name:LIOTTA, LORRAINE (OTR)
Entity Type:Individual
Prefix:MRS
First Name:LORRAINE
Middle Name:
Last Name:LIOTTA
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 1:37 BLACK LOCUST AVE
Mailing Address - Street 2:
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-3446
Mailing Address - Country:US
Mailing Address - Phone:631-642-2027
Mailing Address - Fax:
Practice Address - Street 1:37 BLACK LOCUST AVE
Practice Address - Street 2:
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-3446
Practice Address - Country:US
Practice Address - Phone:631-642-2027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008209-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist