Healthcare Provider Details

I. General information

NPI: 1922170232
Provider Name (Legal Business Name): LORA HOLLIFIELD TORRES OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LORA REBECCA HOLLIFIELD OTR

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 04/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W MICHIGAN ST
ORLANDO FL
32805-6203
US

IV. Provider business mailing address

175 THORNBURY DR
KISSIMMEE FL
34744-8464
US

V. Phone/Fax

Practice location:
  • Phone: 407-317-7430
  • Fax:
Mailing address:
  • Phone: 407-973-0539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT6750
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT6750
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: