Healthcare Provider Details

I. General information

NPI: 1952002065
Provider Name (Legal Business Name): LAURA L MCDONALD OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2023
Last Update Date: 03/15/2023
Certification Date: 03/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

551 S HIGLEY RD
MESA AZ
85206-2148
US

IV. Provider business mailing address

551 S HIGLEY RD
MESA AZ
85206-2148
US

V. Phone/Fax

Practice location:
  • Phone: 480-892-9777
  • Fax: 480-635-0222
Mailing address:
  • Phone: 480-892-9777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTH-009115
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOTH-009115
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: