Provider Demographics
NPI:1417025529
Name:SIBLEY, LAURA MICHELLE (OTRL)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:MICHELLE
Last Name:SIBLEY
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:MRS
Other - First Name:LAURA
Other - Middle Name:MICHELLE
Other - Last Name:SUELMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTRL
Mailing Address - Street 1:632 THORNRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-3797
Mailing Address - Country:US
Mailing Address - Phone:636-538-0855
Mailing Address - Fax:
Practice Address - Street 1:632 THORNRIDGE DR.
Practice Address - Street 2:
Practice Address - City:O'FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368
Practice Address - Country:US
Practice Address - Phone:636-538-0855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics