Provider Demographics
NPI:1093067928
Name:JORDAN, LAURA REEVES (OTR/L)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:REEVES
Last Name:JORDAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:ALTA
Other - Last Name:REEVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4560 SE INTERNATIONAL WAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-4628
Mailing Address - Country:US
Mailing Address - Phone:971-206-5140
Mailing Address - Fax:971-206-5211
Practice Address - Street 1:2125 N OLIVE AVE
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-1947
Practice Address - Country:US
Practice Address - Phone:209-216-5648
Practice Address - Fax:209-664-5625
Is Sole Proprietor?:No
Enumeration Date:2012-10-02
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5826225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist