Provider Demographics
NPI:1861604332
Name:SECREST, LORI LYNN (OT)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:LYNN
Last Name:SECREST
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8305 133RD ST E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-2593
Mailing Address - Country:US
Mailing Address - Phone:253-840-1269
Mailing Address - Fax:
Practice Address - Street 1:8305 133RD ST E
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-2593
Practice Address - Country:US
Practice Address - Phone:253-840-1269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00002887174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist