Healthcare Provider Details

I. General information

NPI: 1689618712
Provider Name (Legal Business Name): LORI DELL STEVENS OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13111 N PORT WASHINGTON RD
MEQUON WI
53097-2416
US

IV. Provider business mailing address

8411 W POPLAR DR
MEQUON WI
53097-3143
US

V. Phone/Fax

Practice location:
  • Phone: 262-243-7444
  • Fax: 262-243-7446
Mailing address:
  • Phone: 262-242-1224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number120-026
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: