=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801879408
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LORI WILSON HIATT OTR/L CHT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/29/2005
-----------------------------------------------------
Last Update Date | 02/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 324 NC-105 EXTENSION SUITE 12
-----------------------------------------------------
City | BOONE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28607
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-386-1285
-----------------------------------------------------
Fax | 828-222-6030
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 325 WATER FALLS RD
-----------------------------------------------------
City | BOONE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28607-5690
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-450-0127
-----------------------------------------------------
Fax | 828-386-1285
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225XH1200X
-----------------------------------------------------
Taxonomy Name | Hand Occupational Therapist
-----------------------------------------------------
License Number | 520
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------