Provider Demographics
NPI:1184927329
Name:OROURKE, LORETTA MARIE (COTA)
Entity type:Individual
Prefix:
First Name:LORETTA
Middle Name:MARIE
Last Name:OROURKE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4699 CONTINENTAL DR
Mailing Address - Street 2:LOT#480
Mailing Address - City:HOLIDAY
Mailing Address - State:FL
Mailing Address - Zip Code:34690-5619
Mailing Address - Country:US
Mailing Address - Phone:407-341-1261
Mailing Address - Fax:
Practice Address - Street 1:8733 W YULEE DR
Practice Address - Street 2:
Practice Address - City:HOMOSASSA
Practice Address - State:FL
Practice Address - Zip Code:34448-4222
Practice Address - Country:US
Practice Address - Phone:407-341-1261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-09
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA11129224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant