Provider Demographics
NPI:1871051003
Name:PORTER, LORI (OT)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:PORTER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:
Other - Last Name:SHONKWILER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 790
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-0790
Mailing Address - Country:US
Mailing Address - Phone:606-329-8588
Mailing Address - Fax:606-329-8195
Practice Address - Street 1:3701 LANDSDOWNE DR
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41102-5422
Practice Address - Country:US
Practice Address - Phone:606-324-3005
Practice Address - Fax:606-329-1530
Is Sole Proprietor?:No
Enumeration Date:2019-03-06
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY246996225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist