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NPI Code Detail

MEDICARE: LORI KAYE WOLF OTR/L CHT

MEDICARE: LORI KAYE WOLF OTR/L CHT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225XH1200XHand Occupational Therapist0442AZ

General Provider Information

NPI Number : 1760990972
Entity Type Code : Individual
Provider Name (Legal Business Name) : LORI KAYE WOLF OTR/L CHT
Provider Business Mailing Address
First Line : 11033 N 75TH DR
Second Line :
City : PEORIA
State : AZ
Zip : 85345-5983
Country : US
Telephone Number : 623-330-1833
Fax Number :
Provider Business Practice Location Address
First Line : 5605 W EUGIE AVE STE 215
Second Line :
City : GLENDALE
State : AZ
Zip : 85304-1275
Country : US
Telephone Number : 602-865-5832
Fax Number : 602-865-5857
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/22/2018
Last Update Date : 01/22/2018

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