Provider Demographics
NPI:1750596748
Name:DALLACHEISA, LORI LYNN (MOT, OTRL)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:LYNN
Last Name:DALLACHEISA
Suffix:
Gender:F
Credentials:MOT, OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8346 BUNKER HILL RD SW
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43837-9018
Mailing Address - Country:US
Mailing Address - Phone:740-498-9745
Mailing Address - Fax:740-498-9745
Practice Address - Street 1:8346 BUNKER HILL RD SW
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43837-9018
Practice Address - Country:US
Practice Address - Phone:740-498-9745
Practice Address - Fax:740-498-9745
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT 006314174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist