Provider Demographics
NPI:1700353216
Name:FARERO, LONNI (OTR/L, OTD)
Entity Type:Individual
Prefix:
First Name:LONNI
Middle Name:
Last Name:FARERO
Suffix:
Gender:F
Credentials:OTR/L, OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3215 NE 143RD ST APT B406
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-3791
Mailing Address - Country:US
Mailing Address - Phone:269-998-5735
Mailing Address - Fax:
Practice Address - Street 1:1122 S 216TH ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:WA
Practice Address - Zip Code:98198-8301
Practice Address - Country:US
Practice Address - Phone:206-824-3663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-01
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT60908098225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist