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NPI Code Detail

MEDICARE: LAURA PETIX MS, OTR/L

MEDICARE: LAURA PETIX MS, OTR/L
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225XP0200XPediatric Occupational Therapist16019CA

General Provider Information

NPI Number : 1881055200
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAURA PETIX MS, OTR/L
Provider Business Mailing Address
First Line : 751 ALAMEDA DE LAS PULGAS
Second Line :
City : BELMONT
State : CA
Zip : 94002-1606
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 751 ALAMEDA DE LAS PULGAS
Second Line :
City : BELMONT
State : CA
Zip : 94002-1606
Country : US
Telephone Number : 949-439-4413
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/12/2016
Last Update Date : 06/21/2016

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