Healthcare Provider Details

I. General information

NPI: 1881475507
Provider Name (Legal Business Name): LAURA ELIZABETH ESKEW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2023
Last Update Date: 10/09/2023
Certification Date: 10/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 FLOYD DR
SIKESTON MO
63801-3960
US

IV. Provider business mailing address

PO BOX 608
SIKESTON MO
63801-0608
US

V. Phone/Fax

Practice location:
  • Phone: 573-472-0397
  • Fax: 573-472-0409
Mailing address:
  • Phone: 573-472-0397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number2023040800
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: