Provider Demographics
NPI:1003167347
Name:CECIL, LAURIE A (OTD, OTR/L, DRP)
Entity Type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:A
Last Name:CECIL
Suffix:
Gender:F
Credentials:OTD, OTR/L, DRP
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:
Other - Last Name:BULUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS, OTR/L
Mailing Address - Street 1:146 BOULDER ROCK DR
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-8533
Mailing Address - Country:US
Mailing Address - Phone:908-400-9757
Mailing Address - Fax:
Practice Address - Street 1:1536 N JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-6525
Practice Address - Country:US
Practice Address - Phone:904-475-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-26
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1772225X00000X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist