Provider Demographics
NPI:1346605565
Name:HAULOTTE, LAURA (COTA)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:HAULOTTE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22353 WESTMORELAND RD
Mailing Address - Street 2:
Mailing Address - City:SEDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65301-1052
Mailing Address - Country:US
Mailing Address - Phone:660-619-1874
Mailing Address - Fax:
Practice Address - Street 1:22353 WESTMORELAND RD
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301-1052
Practice Address - Country:US
Practice Address - Phone:660-619-1874
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-15
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014012731224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant