Provider Demographics
NPI:1407801202
Name:JONES, LAURA LEIGH (OTR L CHT)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:LEIGH
Last Name:JONES
Suffix:
Gender:F
Credentials:OTR L CHT
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:LEIGH
Other - Last Name:WHEATON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR L
Mailing Address - Street 1:802 JOHNNIE DODDS BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3183
Mailing Address - Country:US
Mailing Address - Phone:843-856-1634
Mailing Address - Fax:843-856-2534
Practice Address - Street 1:1483 TOBIAS GADSON BLVD
Practice Address - Street 2:SUITE 205B
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-4641
Practice Address - Country:US
Practice Address - Phone:843-766-6494
Practice Address - Fax:843-766-6495
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC01317225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTH1789Medicaid
SCTH1789Medicaid