Provider Demographics
NPI:1972086502
Name:TORRES, LORENZA LEE (COTA)
Entity type:Individual
Prefix:
First Name:LORENZA
Middle Name:LEE
Last Name:TORRES
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 1:104 HARVEY ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61832-6014
Mailing Address - Country:US
Mailing Address - Phone:217-304-9739
Mailing Address - Fax:217-431-3782
Practice Address - Street 1:3222 INDEPENDENCE DR
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-7919
Practice Address - Country:US
Practice Address - Phone:217-304-9739
Practice Address - Fax:217-431-3782
Is Sole Proprietor?:No
Enumeration Date:2018-09-10
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057.001180224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant