Provider Demographics
NPI:1932437696
Name:MITCHELL, LORRAINE RENEE (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:LORRAINE
Middle Name:RENEE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:LORRAINE
Other - Middle Name:RENEE
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OT
Mailing Address - Street 1:413 104TH AVENUE COURT E
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98372
Mailing Address - Country:US
Mailing Address - Phone:253-961-1486
Mailing Address - Fax:
Practice Address - Street 1:413 104TH AVENUE COURT EAST
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98372-6011
Practice Address - Country:US
Practice Address - Phone:253-961-1486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-18
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00001032225X00000X
FLOT 12658225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist