=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720630106
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAURA A. ALLEY OT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/15/2019
-----------------------------------------------------
Last Update Date | 04/11/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1351 FOWLER ST STE 110
-----------------------------------------------------
City | RICHLAND
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 99352-4714
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-942-2574
-----------------------------------------------------
Fax | 509-942-2575
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 550 GAGE BLVD STE 101
-----------------------------------------------------
City | RICHLAND
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 99352-9532
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-942-2574
-----------------------------------------------------
Fax | 509-942-2575
-----------------------------------------------------
=====================================================
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 |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | OT60898315
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------