Provider Demographics
NPI:1932420312
Name:MARQUARDT, LORI SUSAN (OTR)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:SUSAN
Last Name:MARQUARDT
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 1:355 S HARRIS ST
Mailing Address - Street 2:
Mailing Address - City:SALINE
Mailing Address - State:MI
Mailing Address - Zip Code:48176-1515
Mailing Address - Country:US
Mailing Address - Phone:734-429-3442
Mailing Address - Fax:
Practice Address - Street 1:355 S HARRIS ST
Practice Address - Street 2:
Practice Address - City:SALINE
Practice Address - State:MI
Practice Address - Zip Code:48176-1515
Practice Address - Country:US
Practice Address - Phone:734-429-3442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-19
Last Update Date:2010-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201001995225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation