Provider Demographics
NPI:1285855676
Name:HARTLEY, LAURIE J (OT)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:J
Last Name:HARTLEY
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 LAKE OTIS PKWY STE 202
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5225
Mailing Address - Country:US
Mailing Address - Phone:907-563-4263
Mailing Address - Fax:907-563-4266
Practice Address - Street 1:3600 LAKE OTIS PKWY STE 202
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5225
Practice Address - Country:US
Practice Address - Phone:907-563-4263
Practice Address - Fax:907-563-4266
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK463225X00000X, 225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKOT4463Medicaid
AKOT4463Medicaid
AK0000MBBBLMedicare ID - Type UnspecifiedID