Healthcare Provider Details

I. General information

NPI: 1750488334
Provider Name (Legal Business Name): LORRAINE CRISCI OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1280 CREEKSIDE ST SUITE 104
NAPLES FL
34108-1948
US

IV. Provider business mailing address

4952 RUSTIC OAKS CIR
NAPLES FL
34105-4521
US

V. Phone/Fax

Practice location:
  • Phone: 239-514-2310
  • Fax: 239-514-2329
Mailing address:
  • Phone: 239-430-7405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberOT12482
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: