Healthcare Provider Details

I. General information

NPI: 1285841569
Provider Name (Legal Business Name): LORI L. ELIAS OTR, BS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 07/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 GASTON AVE
DALLAS TX
75246
US

IV. Provider business mailing address

5848 KENWOOD AVE
DALLAS TX
75206-5588
US

V. Phone/Fax

Practice location:
  • Phone: 214-820-3437
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number105862
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: