Provider Demographics
NPI:1023453545
Name:HEBBLER, LORA DANIELLE (OT/L)
Entity type:Individual
Prefix:
First Name:LORA
Middle Name:DANIELLE
Last Name:HEBBLER
Suffix:
Gender:F
Credentials:OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 BARCELONA AVE
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080-5302
Mailing Address - Country:US
Mailing Address - Phone:904-344-5210
Mailing Address - Fax:
Practice Address - Street 1:6 BARCELONA AVE
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32080-5302
Practice Address - Country:US
Practice Address - Phone:904-344-5210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-10
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15762225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist