Provider Demographics
NPI:1265165526
Name:FARRIS, LORI KAY
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:KAY
Last Name:FARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7586 S CRESCENT LOOP
Mailing Address - Street 2:
Mailing Address - City:FLORAL CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34436-2901
Mailing Address - Country:US
Mailing Address - Phone:813-679-5090
Mailing Address - Fax:
Practice Address - Street 1:7586 S CRESCENT LOOP
Practice Address - Street 2:
Practice Address - City:FLORAL CITY
Practice Address - State:FL
Practice Address - Zip Code:34436-2901
Practice Address - Country:US
Practice Address - Phone:813-679-5090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-05
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist