Provider Demographics
NPI:1356626436
Name:SMITH, LAURA PEARL
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:PEARL
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3444 82ND AVE NE
Mailing Address - Street 2:
Mailing Address - City:SHEYENNE
Mailing Address - State:ND
Mailing Address - Zip Code:58374-9667
Mailing Address - Country:US
Mailing Address - Phone:701-230-2385
Mailing Address - Fax:
Practice Address - Street 1:806 MORGAN BLVD
Practice Address - Street 2:STE. B
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-5240
Practice Address - Country:US
Practice Address - Phone:956-428-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX211331224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant