Provider Demographics
NPI:1194194258
Name:HAM, LAURA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:HAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 LENTZ DRIVE
Mailing Address - Street 2:
Mailing Address - City:MORRILTON
Mailing Address - State:AR
Mailing Address - Zip Code:72110-3740
Mailing Address - Country:US
Mailing Address - Phone:501-354-1170
Mailing Address - Fax:501-354-0095
Practice Address - Street 1:411 LENTZ RD
Practice Address - Street 2:
Practice Address - City:MORRILTON
Practice Address - State:AR
Practice Address - Zip Code:72110-3740
Practice Address - Country:US
Practice Address - Phone:501-354-1170
Practice Address - Fax:501-354-0095
Is Sole Proprietor?:No
Enumeration Date:2015-09-18
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist