Healthcare Provider Details

I. General information

NPI: 1881486249
Provider Name (Legal Business Name): LAURA DIVENS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2025
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 RIVERSIDE DR
DUBLIN OH
43017-1492
US

IV. Provider business mailing address

4624 BROWNSTONE DR
HILLIARD OH
43026-8917
US

V. Phone/Fax

Practice location:
  • Phone: 614-764-1600
  • Fax:
Mailing address:
  • Phone: 614-432-6867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number06987
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: