Basic Information
Provider Information
NPI: 1003004102
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LOEWENSTEIN
FirstName: LAURIE
MiddleName: CHRISTINA
NamePrefix:  
NameSuffix:  
Credential: OTR
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: WOLF
OtherFirstName: LAURIE
OtherMiddleName: CHRISTINA
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential: OTR
OtherLastNameType: 1
Mailing Information
Address1: 618 SONOMA ST
Address2:  
City: SAN MARCOS
State: CA
PostalCode: 920784250
CountryCode: US
TelephoneNumber: 7605006008
FaxNumber:  
Practice Location
Address1: 354 SANTA FE DR
Address2:  
City: ENCINITAS
State: CA
PostalCode: 920245142
CountryCode: US
TelephoneNumber: 7606336518
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/15/2007
LastUpdateDate: 01/06/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225X00000X17-01264KSN Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist 
225X00000X9382CAY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist 

No ID Information.


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