Provider Demographics
NPI:1225588247
Name:MURRAY, LARAE (OTD, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:LARAE
Middle Name:
Last Name:MURRAY
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:MS
Other - First Name:LARAE
Other - Middle Name:
Other - Last Name:WORTHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9125 US HIGHWAY 19 N
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33782-5406
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4820 PARK BLVD N
Practice Address - Street 2:SUITE E
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-3534
Practice Address - Country:US
Practice Address - Phone:727-369-6355
Practice Address - Fax:727-362-4766
Is Sole Proprietor?:No
Enumeration Date:2016-10-13
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT16409225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist