Provider Demographics
NPI:1083198709
Name:MIKELL, LORI (LMY)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:MIKELL
Suffix:
Gender:F
Credentials:LMY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 MILL PLAIN RD STE 8
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06811-5135
Mailing Address - Country:US
Mailing Address - Phone:203-364-6826
Mailing Address - Fax:
Practice Address - Street 1:12 MILL PLAIN RD STE 8
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06811-5135
Practice Address - Country:US
Practice Address - Phone:203-364-6826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-19
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT009380225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist