Healthcare Provider Details

I. General information

NPI: 1407518731
Provider Name (Legal Business Name): LAURIE H PEMBRIDGE OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2021
Last Update Date: 11/01/2021
Certification Date: 11/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4202 PEACH ST
ERIE PA
16509-1458
US

IV. Provider business mailing address

53 CAMPBELL ST E
WESTFIELD NY
14787-1201
US

V. Phone/Fax

Practice location:
  • Phone: 814-833-2301
  • Fax: 814-833-9230
Mailing address:
  • Phone: 716-338-2013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOC018015
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: