=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508101908
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LORIE SALTZMAN O.T.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/11/2012
-----------------------------------------------------
Last Update Date | 09/25/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 39 SOVEREIGN LN
-----------------------------------------------------
City | FAIRVIEW
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28730-6200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-817-3445
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 39 SOVEREIGN LN
-----------------------------------------------------
City | FAIRVIEW
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28730-6200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-817-3445
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171W00000X
-----------------------------------------------------
Taxonomy Name | Contractor
-----------------------------------------------------
License Number | OT9419
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225XP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Occupational Therapist
-----------------------------------------------------
License Number | OT8720
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------