Provider Demographics
NPI:1710853106
Name:DIAZ CARRILLO, LORENZO (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:LORENZO
Middle Name:
Last Name:DIAZ CARRILLO
Suffix:
Gender:M
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3280 SW 170TH AVE APT 1516
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97003-8610
Mailing Address - Country:US
Mailing Address - Phone:541-740-6204
Mailing Address - Fax:
Practice Address - Street 1:19221 36TH AVE W STE 213
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-5700
Practice Address - Country:US
Practice Address - Phone:425-368-7943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-14
Last Update Date:2025-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT70049130225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand