Provider Demographics
NPI:1407518731
Name:PEMBRIDGE, LAURIE H (OTR/L)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:H
Last Name:PEMBRIDGE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 CAMPBELL ST E
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14787-1201
Mailing Address - Country:US
Mailing Address - Phone:716-338-2013
Mailing Address - Fax:
Practice Address - Street 1:4202 PEACH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16509-1458
Practice Address - Country:US
Practice Address - Phone:814-833-2301
Practice Address - Fax:814-833-9230
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-13
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC018015225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist