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General NPI Number Information
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NPI Number | 1558688481
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Entity Type | Individual
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Provider Name | LAURA P LANGE OTR/L
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Gender | Female
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Dates
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Enumeration Date | 05/03/2010
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Last Update Date | 03/06/2013
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Provider Practice Location Address
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Address Line | 1200 RIVER RD
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City | CONSHOHOCKEN
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State | PA
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Zip | 19428-2442
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Country | US
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Telephone | 215-483-2461
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Fax | 215-483-4597
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Provider Business Mailing Address
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Address Line | 1200 RIVER RD
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City | CONSHOHOCKEN
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State | PA
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Zip | 19428-2442
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Country | US
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Telephone | 215-483-2461
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Fax | 215-483-4597
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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 | OC011349
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | OC011349
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License Number State | PA
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