Healthcare Provider Details

I. General information

NPI: 1720644263
Provider Name (Legal Business Name): LAURENE ELIZABETH FITZPATRICK OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAURENE ELIZABETH MCCLURE OTR

II. Dates (important events)

Enumeration Date: 05/09/2019
Last Update Date: 05/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3630 MISSION AVE
CARMICHAEL CA
95608-2933
US

IV. Provider business mailing address

4620 MINNESOTA AVE
FAIR OAKS CA
95628-5803
US

V. Phone/Fax

Practice location:
  • Phone: 916-488-1580
  • Fax:
Mailing address:
  • Phone: 916-832-4780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number4348
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: