Provider Demographics
NPI:1477782837
Name:OTT, LAURA J (LPN)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:J
Last Name:OTT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1631 DOGTOWN RD
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44847-9768
Mailing Address - Country:US
Mailing Address - Phone:419-465-4627
Mailing Address - Fax:
Practice Address - Street 1:1631 DOGTOWN RD
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:OH
Practice Address - Zip Code:44847-9768
Practice Address - Country:US
Practice Address - Phone:419-465-4627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-07
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN107149164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse