Healthcare Provider Details

I. General information

NPI: 1225925522
Provider Name (Legal Business Name): LAURA OCAMPO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2025
Last Update Date: 06/19/2025
Certification Date: 06/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5367 NW RUGBY DR
PORT SAINT LUCIE FL
34983-3386
US

IV. Provider business mailing address

891 SW ROCKY BAYOU TER
PORT ST LUCIE FL
34986-2067
US

V. Phone/Fax

Practice location:
  • Phone: 772-216-3634
  • Fax: 772-446-3061
Mailing address:
  • Phone: 678-314-5786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSZ12160
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: