Provider Demographics
NPI:1730425216
Name:FOUST, LORA KAY (OTR/L, SCLV)
Entity type:Individual
Prefix:
First Name:LORA
Middle Name:KAY
Last Name:FOUST
Suffix:
Gender:F
Credentials:OTR/L, SCLV
Other - Prefix:
Other - First Name:LORA
Other - Middle Name:KAY
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:4505 W SUPERIOR ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55807-2728
Mailing Address - Country:US
Mailing Address - Phone:218-624-4828
Mailing Address - Fax:218-624-4479
Practice Address - Street 1:4505 W SUPERIOR ST
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55807-2728
Practice Address - Country:US
Practice Address - Phone:218-624-4828
Practice Address - Fax:218-624-4479
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-02
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN100076225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN100076OtherSTATE LICENSURE