Healthcare Provider Details

I. General information

NPI: 1205056926
Provider Name (Legal Business Name): LAURA B MORA O.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA MORA O.T.

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221US HIGHWAY 41 SUITE G
SCHERERVILLE IN
46375
US

IV. Provider business mailing address

1642 HARTLEY DR
SCHERERVILLE IN
46375-2200
US

V. Phone/Fax

Practice location:
  • Phone: 219-322-2037
  • Fax: 219-322-9787
Mailing address:
  • Phone: 219-322-2037
  • Fax: 219-322-9787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number31002534A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: