Provider Demographics
NPI:1164996575
Name:WAMSLEY, LAURA (ATC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:WAMSLEY
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1251 OLD LERONA RD
Mailing Address - Street 2:
Mailing Address - City:LERONA
Mailing Address - State:WV
Mailing Address - Zip Code:25971-9280
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1251 OLD LERONA RD
Practice Address - Street 2:
Practice Address - City:LERONA
Practice Address - State:WV
Practice Address - Zip Code:25971-9280
Practice Address - Country:US
Practice Address - Phone:540-421-7870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-18
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer