Healthcare Provider Details

I. General information

NPI: 1821622606
Provider Name (Legal Business Name): LAURA JOAN MARDEN CPO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2020
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1389 W MAIN ST
LEXINGTON KY
40508-2047
US

IV. Provider business mailing address

1701 WOODLARK AVE
LEXINGTON KY
40505-1421
US

V. Phone/Fax

Practice location:
  • Phone: 859-880-3737
  • Fax:
Mailing address:
  • Phone: 573-462-0261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number282014
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number282014
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: