Provider Demographics
NPI:1477249043
Name:MARLEY, LAURA ELIZABETH
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ELIZABETH
Last Name:MARLEY
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 1:3272 N 1000 ST
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:IL
Mailing Address - Zip Code:62080-4141
Mailing Address - Country:US
Mailing Address - Phone:217-827-5392
Mailing Address - Fax:
Practice Address - Street 1:3272 N 1000 ST
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:IL
Practice Address - Zip Code:62080-4141
Practice Address - Country:US
Practice Address - Phone:217-827-5392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-17
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist