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General NPI Number Information
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NPI Number | 1376364620
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Entity Type | Individual
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Provider Name | LAURA K CULVERHOUSE
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Gender | Female
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Dates
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Enumeration Date | 10/21/2024
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Last Update Date | 10/21/2024
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Provider Practice Location Address
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Address Line | 801 OAK ST
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City | GREEN COVE SPRINGS
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State | FL
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Zip | 32043-4317
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Country | US
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Telephone | 904-284-9230
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Fax |
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Provider Business Mailing Address
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Address Line | 2863 LONGLEAF RANCH CIR
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City | MIDDLEBURG
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State | FL
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Zip | 32068-6353
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Country | US
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Telephone | 205-603-9068
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | OTA12292
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License Number State | FL
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