Healthcare Provider Details

I. General information

NPI: 1467184903
Provider Name (Legal Business Name): LAURA JORDAN HURLEY OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2022
Last Update Date: 06/24/2022
Certification Date: 06/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20783 N 83RD AVE STE 103
PEORIA AZ
85382-7430
US

IV. Provider business mailing address

10030 N 43RD AVE APT 2024
GLENDALE AZ
85302-2739
US

V. Phone/Fax

Practice location:
  • Phone: 623-444-8880
  • Fax:
Mailing address:
  • Phone: 605-505-1066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTH008840
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: