Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | OT00000415 | WA |
N | 225XH1200X | Occupational Therapist - Hand | OT00000415 | WA |
NPI | 1255368692 |
---|---|
Provider Name | Lori Faye Libolt |
First Address | Lynden, WA 98264-9337 |
Second Address | Lynden, WA 98264-1539 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8340549 | (05) | WA |