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General NPI Number Information
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NPI Number | 1225261654
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Entity Type | Individual
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Provider Name | LAURA SUSANNE NOVAK OTR
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Gender | Female
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Dates
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Enumeration Date | 09/02/2009
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Last Update Date | 07/18/2018
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Provider Practice Location Address
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Address Line | 721 SAN GABRIEL LOOP
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City | NEW BRAUNFELS
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State | TX
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Zip | 78132
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Country | US
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Telephone | 703-615-0107
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Fax |
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Provider Business Mailing Address
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Address Line | 721 SAN GABRIEL LOOP
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City | NEW BRAUNFELS
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State | TX
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Zip | 78132-2903
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Country | US
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Telephone | 703-615-0107
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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 | 0119004623
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 113653
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License Number State | TX
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