Healthcare Provider Details

I. General information

NPI: 1780825299
Provider Name (Legal Business Name): LAURA CROWE SOBOL OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2009
Last Update Date: 03/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3334 PEACHTREE RD NE SUITE #1507
ATLANTA GA
30326-6801
US

IV. Provider business mailing address

3334 PEACHTREE RD NE SUITE #1507
ATLANTA GA
30326-6801
US

V. Phone/Fax

Practice location:
  • Phone: 404-798-8809
  • Fax: 404-201-2928
Mailing address:
  • Phone: 404-798-8809
  • Fax: 404-201-2928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT 3376
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: