Provider Demographics
NPI:1245523901
Name:CHINN, LORI NICHOLE (LMT)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:NICHOLE
Last Name:CHINN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 BURNSED PL
Mailing Address - Street 2:SUITE 1020
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-6695
Mailing Address - Country:US
Mailing Address - Phone:407-971-3898
Mailing Address - Fax:407-971-3840
Practice Address - Street 1:100 BURNSED PL
Practice Address - Street 2:SUITE 1020
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-6695
Practice Address - Country:US
Practice Address - Phone:407-971-3898
Practice Address - Fax:407-971-3840
Is Sole Proprietor?:No
Enumeration Date:2011-05-27
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA62754171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor