Provider Demographics
NPI:1649315151
Name:ELSTON, LORIANN J
Entity type:Individual
Prefix:
First Name:LORIANN
Middle Name:J
Last Name:ELSTON
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 1:119 CHANCE RD
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28115-9709
Mailing Address - Country:US
Mailing Address - Phone:570-866-0854
Mailing Address - Fax:704-360-4058
Practice Address - Street 1:119 CHANCE RD
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28115-9709
Practice Address - Country:US
Practice Address - Phone:570-866-0854
Practice Address - Fax:704-360-4058
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC001749L225X00000X
FL21122225X00000X
NC16075225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001761027OtherMEDICAL ASSISTANCE