Provider Demographics
NPI:1699113381
Name:CONSOLAZIO, LORRAINE LAMOINE (OTR)
Entity type:Individual
Prefix:MRS
First Name:LORRAINE
Middle Name:LAMOINE
Last Name:CONSOLAZIO
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3003 SW 162ND ST
Mailing Address - Street 2:
Mailing Address - City:ARCHER
Mailing Address - State:FL
Mailing Address - Zip Code:32618-2037
Mailing Address - Country:US
Mailing Address - Phone:352-495-5644
Mailing Address - Fax:
Practice Address - Street 1:5930 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-4702
Practice Address - Country:US
Practice Address - Phone:352-332-2629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-05
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT10857225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist