Healthcare Provider Details

I. General information

NPI: 1669573325
Provider Name (Legal Business Name): LAURA SANTURRI HOLMES M.S., OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 11/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1039 TORRENCE DR
APEX NC
27502-4190
US

IV. Provider business mailing address

1039 TORRENCE DR
APEX NC
27502-4190
US

V. Phone/Fax

Practice location:
  • Phone: 919-355-8370
  • Fax:
Mailing address:
  • Phone: 919-355-8370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT11451
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number10106
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier830087900
Identifier TypeMEDICAID
Identifier StateFL
Identifier Issuer
# 2
Identifier108259600
Identifier TypeMEDICAID
Identifier StateFL
Identifier IssuerFlorida Medicaid Provider ID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: