Provider Demographics
NPI:1093817520
Name:MCINTOSH, LAURIE SWIFT (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:SWIFT
Last Name:MCINTOSH
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 BELLAMY RD
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-4350
Mailing Address - Country:US
Mailing Address - Phone:603-742-2448
Mailing Address - Fax:
Practice Address - Street 1:73 BELLAMY RD
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-4350
Practice Address - Country:US
Practice Address - Phone:603-742-2448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0387225X00000X
MEOT126225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME039131OtherANTHEM, MAINE ID
NH13Y005371NH01OtherANTHEM BILLING ID
NH30010133Medicaid
NH30497YMedicare UPIN
NH389220Medicare UPIN