Provider Demographics
NPI:1912083098
Name:BRONSON, LORI LOUANNE (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:LOUANNE
Last Name:BRONSON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5810 KAREN DR
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72118-1233
Mailing Address - Country:US
Mailing Address - Phone:501-851-7981
Mailing Address - Fax:501-851-7981
Practice Address - Street 1:2615 W MAIN ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72076-4215
Practice Address - Country:US
Practice Address - Phone:501-982-4578
Practice Address - Fax:501-982-1253
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR1368225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics