Provider Demographics
NPI:1003036443
Name:SALEM, LAURA E
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:E
Last Name:SALEM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2000
Mailing Address - Street 2:
Mailing Address - City:MORIARTY
Mailing Address - State:NM
Mailing Address - Zip Code:87035-2000
Mailing Address - Country:US
Mailing Address - Phone:505-832-5817
Mailing Address - Fax:505-832-5918
Practice Address - Street 1:200 CENTER STREET
Practice Address - Street 2:
Practice Address - City:MORIARTY
Practice Address - State:NM
Practice Address - Zip Code:87035-0000
Practice Address - Country:US
Practice Address - Phone:505-832-5817
Practice Address - Fax:505-832-5918
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM653225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMZ2875Medicaid