Provider Demographics
NPI:1407574585
Name:LOOBY, LAURA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:LOOBY
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 1:279 PAINE DISTRICT RD
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:CT
Mailing Address - Zip Code:06281-1620
Mailing Address - Country:US
Mailing Address - Phone:860-377-3862
Mailing Address - Fax:
Practice Address - Street 1:279 PAINE DISTRICT RD
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:CT
Practice Address - Zip Code:06281-1620
Practice Address - Country:US
Practice Address - Phone:860-377-3862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-16
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist