Provider Demographics
NPI:1417467887
Name:MESSMER, LAURA BETH (OTR)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:BETH
Last Name:MESSMER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 LESLIE DR
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-1211
Mailing Address - Country:US
Mailing Address - Phone:812-827-6242
Mailing Address - Fax:
Practice Address - Street 1:4851 TINCHER RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46221-3780
Practice Address - Country:US
Practice Address - Phone:317-856-4851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-11
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY174426225X00000X
IN31006449A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist