Healthcare Provider Details

I. General information

NPI: 1780848564
Provider Name (Legal Business Name): LAURA MARIE CONWAY OTR/L, CHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2008
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2318 GREENBRANCH DR
WESLEY CHAPEL FL
33544-6797
US

IV. Provider business mailing address

707 SEAGATE DR
TAMPA FL
33602-5789
US

V. Phone/Fax

Practice location:
  • Phone: 813-738-9680
  • Fax:
Mailing address:
  • Phone: 631-291-6716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number013477-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number13272
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: