Provider Demographics
NPI:1700913845
Name:POP, LORELLE JEAN (OT)
Entity Type:Individual
Prefix:MRS
First Name:LORELLE
Middle Name:JEAN
Last Name:POP
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7634 W LAKEVIEW TER
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-8653
Mailing Address - Country:US
Mailing Address - Phone:815-469-0975
Mailing Address - Fax:
Practice Address - Street 1:350 HOUBOLT RD
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60431-8305
Practice Address - Country:US
Practice Address - Phone:815-725-9992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist