Healthcare Provider Details

I. General information

NPI: 1245255280
Provider Name (Legal Business Name): LAURANN MARIE PUTNAM OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 09/11/2023
Certification Date: 09/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 ROYCE ST STE E
LOS GATOS CA
95030-6041
US

IV. Provider business mailing address

114 ROYCE ST STE E
LOS GATOS CA
95030-6041
US

V. Phone/Fax

Practice location:
  • Phone: 408-358-1460
  • Fax: 408-358-1459
Mailing address:
  • Phone: 408-358-1460
  • Fax: 408-358-1459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT1479
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: