Provider Demographics
NPI:1720664501
Name:KLINE, LOREN (COTA/L)
Entity Type:Individual
Prefix:
First Name:LOREN
Middle Name:
Last Name:KLINE
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17111 KENTON DR STE 206B
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-5650
Mailing Address - Country:US
Mailing Address - Phone:704-237-4105
Mailing Address - Fax:704-237-4107
Practice Address - Street 1:17111 KENTON DR STE 206B
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-5650
Practice Address - Country:US
Practice Address - Phone:704-237-4105
Practice Address - Fax:704-237-4107
Is Sole Proprietor?:No
Enumeration Date:2021-03-22
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13968224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC13968OtherNCBOT