Provider Demographics
NPI:1023477700
Name:SMITH, LORA BEA (MS, OTR/L)
Entity type:Individual
Prefix:MRS
First Name:LORA
Middle Name:BEA
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8995 SW MILEY RD STE 109
Mailing Address - Street 2:
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-5485
Mailing Address - Country:US
Mailing Address - Phone:503-694-8366
Mailing Address - Fax:503-694-8581
Practice Address - Street 1:8995 SW MILEY RD STE 109
Practice Address - Street 2:
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-5485
Practice Address - Country:US
Practice Address - Phone:503-694-8366
Practice Address - Fax:503-694-8581
Is Sole Proprietor?:No
Enumeration Date:2016-02-23
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR353025225X00000X, 225XH1200X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand