Provider Demographics
NPI:1073281846
Name:LAUDAT, TAMINA (COTA/L)
Entity Type:Individual
Prefix:
First Name:TAMINA
Middle Name:
Last Name:LAUDAT
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 RIDGEWOOD PKWY
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23602-4415
Mailing Address - Country:US
Mailing Address - Phone:757-886-6500
Mailing Address - Fax:
Practice Address - Street 1:4 RIDGEWOOD PKWY
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-4415
Practice Address - Country:US
Practice Address - Phone:757-886-6500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-05
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131001096224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant