Provider Demographics
NPI:1376557421
Name:FAIRFIELD, LAURA SUZANNE (OTR)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:SUZANNE
Last Name:FAIRFIELD
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MISS
Other - First Name:LAURA
Other - Middle Name:SUZANNE
Other - Last Name:ROSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:6342 WINDHAM PL
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-9127
Mailing Address - Country:US
Mailing Address - Phone:810-606-8170
Mailing Address - Fax:
Practice Address - Street 1:5315 ELLIOTT DR
Practice Address - Street 2:STE 202
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-8634
Practice Address - Country:US
Practice Address - Phone:734-712-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201004568225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist