Healthcare Provider Details

I. General information

NPI: 1801954862
Provider Name (Legal Business Name): LAUREL L BAXLA OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 SW 14TH ST
OCALA FL
34474-3215
US

IV. Provider business mailing address

425 SW 14TH ST
OCALA FL
34474-3215
US

V. Phone/Fax

Practice location:
  • Phone: 352-351-8300
  • Fax: 352-351-8310
Mailing address:
  • Phone: 352-351-8300
  • Fax: 352-351-8310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT-8330
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: