Provider Demographics
NPI:1902100357
Name:LANG, LORI P (OTR)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:P
Last Name:LANG
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 1:13265 HARVEST RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-8126
Mailing Address - Country:US
Mailing Address - Phone:817-490-1249
Mailing Address - Fax:
Practice Address - Street 1:13265 HARVEST RIDGE RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-8126
Practice Address - Country:US
Practice Address - Phone:817-490-1249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-28
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105893225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist