Healthcare Provider Details

I. General information

NPI: 1821236795
Provider Name (Legal Business Name): LAURA S PELHAM OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2009
Last Update Date: 01/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 HOWELL BRANCH RD STE B1
WINTER PARK FL
32789-1170
US

IV. Provider business mailing address

1555 HOWELL BRANCH ROAD, SUITE B1
WINTER PARK FL
32789
US

V. Phone/Fax

Practice location:
  • Phone: 407-645-4574
  • Fax:
Mailing address:
  • Phone: 407-645-4574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number0855
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: