Provider Demographics
NPI:1346622669
Name:LAUGHLIN, FONDA KAY (MT-BC, MA)
Entity Type:Individual
Prefix:
First Name:FONDA
Middle Name:KAY
Last Name:LAUGHLIN
Suffix:
Gender:F
Credentials:MT-BC, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 WILLIAMSBURG RD
Mailing Address - Street 2:APT. 1N
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-6314
Mailing Address - Country:US
Mailing Address - Phone:417-773-8352
Mailing Address - Fax:
Practice Address - Street 1:1800 WILLIAMSBURG RD
Practice Address - Street 2:APT. 1N
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-6314
Practice Address - Country:US
Practice Address - Phone:417-773-8352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-23
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10792225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist