Provider Demographics
NPI:1164132502
Name:MCKEMIE, LAURA (LMT)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:
Last Name:MCKEMIE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 LEGEND CREEK DR
Mailing Address - Street 2:
Mailing Address - City:YOUNGSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70592-5763
Mailing Address - Country:US
Mailing Address - Phone:337-326-2035
Mailing Address - Fax:
Practice Address - Street 1:100 LEGEND CREEK DR
Practice Address - Street 2:
Practice Address - City:YOUNGSVILLE
Practice Address - State:LA
Practice Address - Zip Code:70592-5763
Practice Address - Country:US
Practice Address - Phone:337-326-2035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
156F00000X, 171400000X
LA3265225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No156F00000XEye and Vision Services ProvidersTechnician/Technologist
No171400000XOther Service ProvidersHealth & Wellness Coach