Healthcare Provider Details

I. General information

NPI: 1013221365
Provider Name (Legal Business Name): LAURA JEAN HOGAN-REYES OTR/L, SWC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2010
Last Update Date: 07/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E DEL MAR BLVD #112
PASADENA CA
91105-2544
US

IV. Provider business mailing address

200 E DEL MAR BLVD #112
PASADENA CA
91105-2544
US

V. Phone/Fax

Practice location:
  • Phone: 626-564-2700
  • Fax:
Mailing address:
  • Phone: 626-564-2700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number1341
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: