MEDICARE: LAURIE J HARTLEY OT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	463	AK
2	225XH1200X	Hand Occupational Therapist	463	AK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285855676
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURIE J HARTLEY OT

Provider Business Mailing Address
First Line	:	3600 LAKE OTIS PKWY STE 202
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99508-5225
Country	:	US
Telephone Number	:	907-563-4263
Fax Number	:	907-563-4266

Provider Business Practice Location Address
First Line	:	3600 LAKE OTIS PKWY STE 202
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99508-5225
Country	:	US
Telephone Number	:	907-563-4263
Fax Number	:	907-563-4266

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2007
Last Update Date	:	09/26/2012

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