Provider Demographics
NPI:1154887867
Name:CORLEY, LORI NOELLE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:NOELLE
Last Name:CORLEY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:NOELLE
Other - Last Name:KERR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:425 E ZARAGOZA ST STE A
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32502-8101
Mailing Address - Country:US
Mailing Address - Phone:205-914-7091
Mailing Address - Fax:
Practice Address - Street 1:4624 SUMMERDALE DR
Practice Address - Street 2:
Practice Address - City:PACE
Practice Address - State:FL
Practice Address - Zip Code:32571-1368
Practice Address - Country:US
Practice Address - Phone:850-994-3456
Practice Address - Fax:850-994-3476
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-18
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT18519225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist