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General NPI Number Information
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NPI Number | 1316455769
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Entity Type | Organization
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Legal Business Name | OT LAURA LLC
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Dates
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Enumeration Date | 01/19/2018
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Last Update Date | 01/19/2018
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Provider Practice Location Address
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Address Line | 36 MAIN ST
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City | PARK RIDGE
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State | IL
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Zip | 60068-4059
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Country | US
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Telephone | 847-692-6692
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Fax |
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Provider Business Mailing Address
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Address Line | 799 GRACELAND AVE UNIT 508
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City | DES PLAINES
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State | IL
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Zip | 60016-8623
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Country | US
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Telephone | 708-724-8780
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Fax |
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST
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Name | LAURA OBRIEN
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Credential | OTR/L
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Telephone | 708-724-8780
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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 |
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License Number State |
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