Provider Demographics
NPI:1477037778
Name:DAVIS, LAUREL B (OTR/L)
Entity Type:Individual
Prefix:
First Name:LAUREL
Middle Name:B
Last Name:DAVIS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:LAUREL
Other - Middle Name:B
Other - Last Name:HALUSKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1504 APPLEFIELD ST
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-5999
Mailing Address - Country:US
Mailing Address - Phone:703-989-0737
Mailing Address - Fax:
Practice Address - Street 1:1504 APPLEFIELD ST
Practice Address - Street 2:
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320-5999
Practice Address - Country:US
Practice Address - Phone:703-989-0737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-21
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT19133225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOT19133OtherCALIFORNIA BOARD OF OCCUPATIONAL THERAPY
402182OtherNBCOT