Healthcare Provider Details

I. General information

NPI: 1336336346
Provider Name (Legal Business Name): LAURA JEAN WATROUS OTR/L, CLT-LANA, CHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2007
Last Update Date: 12/07/2021
Certification Date: 12/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

377 SYLVAN LAKE RD STE 130
EAGLE CO
81631-6779
US

IV. Provider business mailing address

PO BOX 40000
VAIL CO
81658-7520
US

V. Phone/Fax

Practice location:
  • Phone: 970-328-6715
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number2963
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number2963
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: