Provider Demographics
NPI:1417164187
Name:SNYDER, LAURA LEE (OCCUPATIONAL THERAPI)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:LEE
Last Name:SNYDER
Suffix:
Gender:F
Credentials:OCCUPATIONAL THERAPI
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:LEE
Other - Last Name:HURWITZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 8600
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04104
Mailing Address - Country:US
Mailing Address - Phone:207-774-6323
Mailing Address - Fax:207-761-8460
Practice Address - Street 1:75 WASHINGTON AVE
Practice Address - Street 2:STE 300
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-2665
Practice Address - Country:US
Practice Address - Phone:207-761-8402
Practice Address - Fax:207-761-8405
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT242225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME039161OtherANTHEM
MESNME1022Medicare ID - Type Unspecified