Provider Demographics
NPI:1548777022
Name:NANOLA, LOREVIE (OTR/L)
Entity type:Individual
Prefix:
First Name:LOREVIE
Middle Name:
Last Name:NANOLA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 N UNION ST APT 3
Mailing Address - Street 2:
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760-1384
Mailing Address - Country:US
Mailing Address - Phone:609-500-6432
Mailing Address - Fax:
Practice Address - Street 1:15 W WILLOW ST
Practice Address - Street 2:
Practice Address - City:SMETHPORT
Practice Address - State:PA
Practice Address - Zip Code:16749-1523
Practice Address - Country:US
Practice Address - Phone:814-887-5716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-05
Last Update Date:2018-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC015334225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist