Healthcare Provider Details

I. General information

NPI: 1114370228
Provider Name (Legal Business Name): LAURA MINTON MS, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2016
Last Update Date: 10/01/2021
Certification Date: 10/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6148 LOMA AVE
TEMPLE CITY CA
91780-1632
US

IV. Provider business mailing address

6148 LOMA AVE
TEMPLE CITY CA
91780-1632
US

V. Phone/Fax

Practice location:
  • Phone: 626-765-4797
  • Fax:
Mailing address:
  • Phone: 626-765-4797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT16395
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: