Provider Demographics
NPI:1326167701
Name:ESTANISLAU, LAURA STUTZ (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:STUTZ
Last Name:ESTANISLAU
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5742 FURNACE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-6020
Mailing Address - Country:US
Mailing Address - Phone:949-533-1141
Mailing Address - Fax:
Practice Address - Street 1:16052 BEACH BLVD
Practice Address - Street 2:SUITE 135
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-3801
Practice Address - Country:US
Practice Address - Phone:949-533-1141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 2878225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist