Provider Demographics
NPI:1558637546
Name:ESOLDO, LAURA M (OT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:M
Last Name:ESOLDO
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1817 BRIARCREEK LN
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17057-2976
Mailing Address - Country:US
Mailing Address - Phone:717-519-7176
Mailing Address - Fax:
Practice Address - Street 1:1817 BRIARCREEK LN
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:PA
Practice Address - Zip Code:17057-2976
Practice Address - Country:US
Practice Address - Phone:717-519-7176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-24
Last Update Date:2012-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDT00928225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist