Provider Demographics
NPI:1316403280
Name:MINTHORNE, LAURA (OTD, OTR/L)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:
Last Name:MINTHORNE
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2405 NE JOHN OLSEN AVE APT 322
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97006-6759
Mailing Address - Country:US
Mailing Address - Phone:503-758-0939
Mailing Address - Fax:
Practice Address - Street 1:23839 SW DANIEL RD
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97078-5400
Practice Address - Country:US
Practice Address - Phone:503-217-2058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-15
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR386697225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist