Provider Demographics
NPI:1487053617
Name:HENRICKSEN, LORI (MS, OTR/L-BCP)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:HENRICKSEN
Suffix:
Gender:F
Credentials:MS, OTR/L-BCP
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:
Other - Last Name:HENRICKSEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, OTR/L-BCP
Mailing Address - Street 1:2900 NE 30TH ST
Mailing Address - Street 2:7G
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33306-1927
Mailing Address - Country:US
Mailing Address - Phone:954-654-1243
Mailing Address - Fax:954-533-4572
Practice Address - Street 1:2900 NE 30TH ST
Practice Address - Street 2:7G
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33306-1927
Practice Address - Country:US
Practice Address - Phone:954-654-1243
Practice Address - Fax:954-533-4572
Is Sole Proprietor?:No
Enumeration Date:2014-08-13
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT12246225XP0200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist