Provider Demographics
NPI:1700096179
Name:LABADI, LORA MICHELLE (DT)
Entity Type:Individual
Prefix:
First Name:LORA
Middle Name:MICHELLE
Last Name:LABADI
Suffix:
Gender:F
Credentials:DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 W ELLEN AVE
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60112-4120
Mailing Address - Country:US
Mailing Address - Phone:815-754-4994
Mailing Address - Fax:
Practice Address - Street 1:212 W ELLEN AVE
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:IL
Practice Address - Zip Code:60112-4120
Practice Address - Country:US
Practice Address - Phone:815-754-4994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL222Q00000X222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist