Provider Demographics
NPI:1184080616
Name:LAWRENCE, LORI LOUISE (OTR/L)
Entity type:Individual
Prefix:
First Name:LORI LOUISE
Middle Name:
Last Name:LAWRENCE
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 1:1227 KAWANA TER APT 7111
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-6365
Mailing Address - Country:US
Mailing Address - Phone:707-486-3127
Mailing Address - Fax:
Practice Address - Street 1:684 BENICIA DR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95409-3058
Practice Address - Country:US
Practice Address - Phone:707-573-4513
Practice Address - Fax:707-573-4510
Is Sole Proprietor?:No
Enumeration Date:2016-01-13
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12910225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist