Healthcare Provider Details

I. General information

NPI: 1841520517
Provider Name (Legal Business Name): MARY LAUGHERY OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/01/2010
Last Update Date: 01/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 LAKEVIEW DR
CHARLESTON WV
25313-1467
US

IV. Provider business mailing address

113 LAKEVIEW DR
CHARLESTON WV
25313-1467
US

V. Phone/Fax

Practice location:
  • Phone: 304-342-9515
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number974
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: