Provider Demographics
NPI:1013195064
Name:WHITE, LAURA ANN (OTRL)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:ANN
Last Name:WHITE
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 CLARA DR
Mailing Address - Street 2:VISIONS SIGHT AND LEARNING CENTER
Mailing Address - City:MYSTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06355
Mailing Address - Country:US
Mailing Address - Phone:860-572-4805
Mailing Address - Fax:860-572-4810
Practice Address - Street 1:23 CLARA DR
Practice Address - Street 2:VISIONS SIGHT AND LEARNING CENTER
Practice Address - City:MYSTIC
Practice Address - State:CT
Practice Address - Zip Code:06355
Practice Address - Country:US
Practice Address - Phone:860-572-4805
Practice Address - Fax:860-572-4810
Is Sole Proprietor?:No
Enumeration Date:2008-02-01
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002286152WV0400X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy