Provider Demographics
NPI:1275165383
Name:MARTIN, LAURIE BOGGUS (OTR)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:BOGGUS
Last Name:MARTIN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:296 BROAD RIVER DR
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29906-6953
Mailing Address - Country:US
Mailing Address - Phone:843-252-1534
Mailing Address - Fax:
Practice Address - Street 1:296 BROAD RIVER DR
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29906-6953
Practice Address - Country:US
Practice Address - Phone:843-252-1534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-06
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2324225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist