Healthcare Provider Details

I. General information

NPI: 1942135215
Provider Name (Legal Business Name): MIA JOAN LAWRENCE MS, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 CARNEGIE PLZ
CHERRY HILL NJ
08003-1000
US

IV. Provider business mailing address

24 SANFORDS BRG
EAST HADDAM CT
06423-1559
US

V. Phone/Fax

Practice location:
  • Phone: 877-407-3422
  • Fax:
Mailing address:
  • Phone: 860-759-5549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number6826
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: