Provider Demographics
NPI:1174926661
Name:ESPINOSA, LORI DENISE (COTA)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:DENISE
Last Name:ESPINOSA
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 1:2613 NE EVERETT ST
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-9557
Mailing Address - Country:US
Mailing Address - Phone:360-834-4479
Mailing Address - Fax:
Practice Address - Street 1:13501 NE 28TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98682-8091
Practice Address - Country:US
Practice Address - Phone:360-604-4014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-29
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA224Z00000XMedicaid