Healthcare Provider Details

I. General information

NPI: 1649416132
Provider Name (Legal Business Name): LAURA H ESTRADA OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2009
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2415 MCCALLIE AVE
CHATTANOOGA TN
37404-3322
US

IV. Provider business mailing address

2415 MCCALLIE AVE
CHATTANOOGA TN
37404-3322
US

V. Phone/Fax

Practice location:
  • Phone: 423-622-6200
  • Fax: 423-697-2025
Mailing address:
  • Phone: 423-622-6200
  • Fax: 423-697-2025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberGA PT004806
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: