Healthcare Provider Details

I. General information

NPI: 1205021730
Provider Name (Legal Business Name): LORI LEWIS B.S., ITFS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2007
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 WALL R., STE 100
WAKE FOREST NC
27587
US

IV. Provider business mailing address

1340 WALL R., STE 100
WAKE FOREST NC
27587
US

V. Phone/Fax

Practice location:
  • Phone: 919-810-2792
  • Fax:
Mailing address:
  • Phone: 919-810-2792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: