Healthcare Provider Details

I. General information

NPI: 1962517334
Provider Name (Legal Business Name): LAURI R. MICHAELS O.T.R./L., C.H.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 20TH ST APT. 2
SANTA MONICA CA
90403-2043
US

IV. Provider business mailing address

810 20TH ST APT. 2
SANTA MONICA CA
90403-2043
US

V. Phone/Fax

Practice location:
  • Phone: 310-453-2120
  • Fax:
Mailing address:
  • Phone: 310-453-2120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License NumberOT 2663
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: