Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 01265 | IA |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 01265 | IA |
N | 225XP0200X | Occupational Therapist - Pediatrics | 01265 | IA |
NPI | 1265747612 |
---|---|
Provider Name | Ms. Lorelei Lc Titus-Hooper |
First Address | Fort Madison, IA 52627-9761 |
Second Address | Fort Madison, IA 52627-9761 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2010 |
Last Update Date | 10/08/2010 |