Provider Demographics
NPI:1306455290
Name:NEAL, LORRIE ANN (COTA)
Entity type:Individual
Prefix:MS
First Name:LORRIE
Middle Name:ANN
Last Name:NEAL
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 MULLINS ST
Mailing Address - Street 2:
Mailing Address - City:TATUM
Mailing Address - State:TX
Mailing Address - Zip Code:75691-9512
Mailing Address - Country:US
Mailing Address - Phone:903-470-0997
Mailing Address - Fax:
Practice Address - Street 1:285 MULLINS ST
Practice Address - Street 2:
Practice Address - City:TATUM
Practice Address - State:TX
Practice Address - Zip Code:75691-9512
Practice Address - Country:US
Practice Address - Phone:903-470-0997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-27
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX216311224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant