Provider Demographics
NPI:1093158545
Name:WYLIE, LAURA (MSOTR/L)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:
Last Name:WYLIE
Suffix:
Gender:F
Credentials:MSOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 BEAGLE GAP RUN
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:VA
Mailing Address - Zip Code:22980-9321
Mailing Address - Country:US
Mailing Address - Phone:434-284-3011
Mailing Address - Fax:
Practice Address - Street 1:214 BEAGLE GAP RUN
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:VA
Practice Address - Zip Code:22980-9321
Practice Address - Country:US
Practice Address - Phone:434-284-3011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-15
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119005938225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist