Provider Demographics
NPI:1518224526
Name:DENNIS, LAURA NICOLE (ATC)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:NICOLE
Last Name:DENNIS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:MISS
Other - First Name:LAURA
Other - Middle Name:NICOLE
Other - Last Name:REIMINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:1008 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SIKESTON
Mailing Address - State:MO
Mailing Address - Zip Code:63801-5044
Mailing Address - Country:US
Mailing Address - Phone:573-472-2663
Mailing Address - Fax:573-472-2669
Practice Address - Street 1:1008 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SIKESTON
Practice Address - State:MO
Practice Address - Zip Code:63801-5044
Practice Address - Country:US
Practice Address - Phone:573-472-2663
Practice Address - Fax:573-472-2669
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-15
Last Update Date:2012-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20060173042255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer