Healthcare Provider Details

I. General information

NPI: 1801231063
Provider Name (Legal Business Name): LAURA ELIZABETH GOLDEN OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2013
Last Update Date: 06/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 CIRCLE DR SUITE 101
FORT WORTH TX
76119-8111
US

IV. Provider business mailing address

3840 HULEN ST
FORT WORTH TX
76107-7277
US

V. Phone/Fax

Practice location:
  • Phone: 817-566-1100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number115447
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code225XF0002X
TaxonomyFeeding, Eating & Swallowing Occupational Therapist
License Number115447
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number115447
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number115447
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number115447
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: