Healthcare Provider Details

I. General information

NPI: 1033260070
Provider Name (Legal Business Name): LAURA E ROADARMEL MSOTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA E NORK MSOTRL

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 02/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1751 E BROAD ST
HAZLETON PA
18201-5650
US

IV. Provider business mailing address

306 WALNUT ST
DANVILLE PA
17821-1551
US

V. Phone/Fax

Practice location:
  • Phone: 570-501-9814
  • Fax:
Mailing address:
  • Phone: 570-594-1068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOC010065
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier2483752
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerAETNA
# 2
Identifier001963462
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerHIGHMARK BLUE SHIELD
# 3
Identifier50066692
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerCAPITAL BLUE CROSS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: