Healthcare Provider Details

I. General information

NPI: 1952592461
Provider Name (Legal Business Name): LAURA THERESE OMOGROSSO OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2007
Last Update Date: 08/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

264 PLEASANT ST
CONCORD NH
03301-2551
US

IV. Provider business mailing address

264 PLEASANT ST
CONCORD NH
03301-2551
US

V. Phone/Fax

Practice location:
  • Phone: 603-228-4610
  • Fax:
Mailing address:
  • Phone: 603-228-4610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number1874
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: