=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144345265
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAURIE LYNN KLING OCCUPATIONAL THERAPI
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/20/2007
-----------------------------------------------------
Last Update Date | 12/17/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10251 NORTH 35TH AVENUE
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85051
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-995-7366
-----------------------------------------------------
Fax | 602-995-0867
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10251 NORTH 35TH AVENUE
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85051
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-995-7366
-----------------------------------------------------
Fax | 602-995-0867
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 100758
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 1682
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 4243
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------