Provider Demographics
NPI:1467651562
Name:ALDERMAN, LAURIE ELIZABETH
Entity Type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:ELIZABETH
Last Name:ALDERMAN
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 1:515 N 17TH ST APT 6
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:MI
Mailing Address - Zip Code:49120-2061
Mailing Address - Country:US
Mailing Address - Phone:269-687-2522
Mailing Address - Fax:
Practice Address - Street 1:515 N 17TH ST APT 6
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:MI
Practice Address - Zip Code:49120-2061
Practice Address - Country:US
Practice Address - Phone:269-687-2522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31004158A225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics