Healthcare Provider Details

I. General information

NPI: 1962019679
Provider Name (Legal Business Name): HADLEY LOLLI OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2020
Last Update Date: 09/27/2020
Certification Date: 09/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5691 NAPLES BLVD
NAPLES FL
34109-2023
US

IV. Provider business mailing address

5691 NAPLES BLVD
NAPLES FL
34109-2023
US

V. Phone/Fax

Practice location:
  • Phone: 239-562-6100
  • Fax: 239-592-6156
Mailing address:
  • Phone: 239-592-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT21198
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: