Provider Demographics
NPI:1063667848
Name:MAALUL, LAURIE B (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:B
Last Name:MAALUL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:LAURIE
Other - Middle Name:B
Other - Last Name:AXELROD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:817 LARAMIE AVE
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-2053
Mailing Address - Country:US
Mailing Address - Phone:847-778-6804
Mailing Address - Fax:847-728-0304
Practice Address - Street 1:817 LARAMIE AVE
Practice Address - Street 2:
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-2053
Practice Address - Country:US
Practice Address - Phone:847-778-6804
Practice Address - Fax:847-728-0304
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-20
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225A00000X
IL056.006890225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist