Provider Demographics
NPI:1518292614
Name:VERA, LAURIE BLANCHARD (MHS, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:BLANCHARD
Last Name:VERA
Suffix:
Gender:F
Credentials:MHS, OTR/L
Other - Prefix:MISS
Other - First Name:LAURIE
Other - Middle Name:COOK
Other - Last Name:BLANCHARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MHS, OTR/L
Mailing Address - Street 1:812 CAMELLIA RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-2734
Mailing Address - Country:US
Mailing Address - Phone:706-495-6548
Mailing Address - Fax:
Practice Address - Street 1:812 CAMELLIA RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-2734
Practice Address - Country:US
Practice Address - Phone:706-495-6548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-07
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT004981225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA304613285ABCMedicaid
258614OtherNBCOT