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General NPI Number Information
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NPI Number | 1114962982
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Entity Type | Individual
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Provider Name | LAURA MOERMAN OTR
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Gender | Female
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Dates
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Enumeration Date | 06/17/2006
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Last Update Date | 05/10/2025
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Provider Practice Location Address
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Address Line | 820 RILEY LN
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City | ST AUGUSTINE
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State | FL
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Zip | 32095-6832
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Country | US
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Telephone | 904-575-1750
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Fax |
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Provider Business Mailing Address
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Address Line | 820 RILEY LN
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City | ST AUGUSTINE
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State | FL
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Zip | 32095-6832
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Country | US
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Telephone | 904-575-1750
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 3038-026
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 225XP0019X
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Taxonomy Name | Physical Rehabilitation Occupational Therapist
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License Number | OT17721
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License Number State | FL
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