MEDICARE: LORI LYNN OTT O.T.

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
1	225X00000X	Occupational Therapist	OT 2425	CA
2	225X00000X	Occupational Therapist	OT-3052	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	WOT2425A	OTHER	CA	MEDICAR PTAN

General Provider Information

NPI Number	:	1821180332
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORI LYNN OTT O.T.

Provider Business Mailing Address
First Line	:	1901 PLACID RAVINE ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-5961
Country	:	US
Telephone Number	:	949-275-2516
Fax Number	:

Provider Business Practice Location Address
First Line	:	4855 BLUE DIAMOND RD STE 210
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89139-7602
Country	:	US
Telephone Number	:	725-207-3770
Fax Number	:	702-505-9020

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2006
Last Update Date	:	10/12/2022

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