Provider Demographics
NPI:1356460620
Name:SEARLES, LAURA MARGUERITE (OTR)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:MARGUERITE
Last Name:SEARLES
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11851 COLMAN TER
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19154-2510
Mailing Address - Country:US
Mailing Address - Phone:215-824-4520
Mailing Address - Fax:
Practice Address - Street 1:2990 HOLME AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19136-1830
Practice Address - Country:US
Practice Address - Phone:215-335-2100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC010392225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA790852OtherMEDICAL LIABILITY INSURAN