Provider Demographics
NPI:1033834213
Name:DAHMER, LAURA NICOLE (LMT)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:NICOLE
Last Name:DAHMER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MISS
Other - First Name:LAURA
Other - Middle Name:NICOLE
Other - Last Name:KINGSLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:11624 E CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-1204
Mailing Address - Country:US
Mailing Address - Phone:303-500-2435
Mailing Address - Fax:
Practice Address - Street 1:11624 E CEDAR AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-1204
Practice Address - Country:US
Practice Address - Phone:303-500-2435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0004574225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist