Healthcare Provider Details

I. General information

NPI: 1710818364
Provider Name (Legal Business Name): LAURIE ANN WOOD MA, OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2026
Last Update Date: 05/25/2026
Certification Date: 05/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 BRISTOL ST
MIDDLETON WI
53562-2746
US

IV. Provider business mailing address

738 CONE FLOWER ST
MIDDLETON WI
53562-5052
US

V. Phone/Fax

Practice location:
  • Phone: 608-215-4404
  • Fax:
Mailing address:
  • Phone: 608-215-4404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2795
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: