Healthcare Provider Details

I. General information

NPI: 1487446936
Provider Name (Legal Business Name): COREY MANUEL LOURENCO OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2025
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69 DRAPER AVE
WARWICK RI
02889-5046
US

IV. Provider business mailing address

69 DRAPER AVE
WARWICK RI
02889-5046
US

V. Phone/Fax

Practice location:
  • Phone: 401-734-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT02354
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: