Provider Demographics
NPI:1932400496
Name:STOTKO, LORI KAY (OTR CHT)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:KAY
Last Name:STOTKO
Suffix:
Gender:F
Credentials:OTR CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 SEA BREEZE DR
Mailing Address - Street 2:
Mailing Address - City:HALF MOON BAY
Mailing Address - State:CA
Mailing Address - Zip Code:94019-2313
Mailing Address - Country:US
Mailing Address - Phone:650-245-2844
Mailing Address - Fax:650-712-0419
Practice Address - Street 1:1155 UNIVERSITY DR
Practice Address - Street 2:SUITE 1
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-4431
Practice Address - Country:US
Practice Address - Phone:650-245-2844
Practice Address - Fax:650-326-5929
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-15
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA521225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand