Provider Demographics
NPI:1952529109
Name:NEELEY, LORRI L (DEVELOPMENTAL THERAP)
Entity Type:Individual
Prefix:
First Name:LORRI
Middle Name:L
Last Name:NEELEY
Suffix:
Gender:F
Credentials:DEVELOPMENTAL THERAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1073 BOTHWELL CIR
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440
Mailing Address - Country:US
Mailing Address - Phone:630-222-1607
Mailing Address - Fax:630-759-0959
Practice Address - Street 1:1073 BOTHWELL CIR
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-1667
Practice Address - Country:US
Practice Address - Phone:630-222-1607
Practice Address - Fax:630-759-0959
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILLN94810300P222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist