Provider Demographics
NPI:1558688481
Name:LANGE, LAURA P (OTR/L)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:P
Last Name:LANGE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-2442
Mailing Address - Country:US
Mailing Address - Phone:215-483-2461
Mailing Address - Fax:215-483-4597
Practice Address - Street 1:1200 RIVER RD
Practice Address - Street 2:
Practice Address - City:CONSHOHOCKEN
Practice Address - State:PA
Practice Address - Zip Code:19428-2442
Practice Address - Country:US
Practice Address - Phone:215-483-2461
Practice Address - Fax:215-483-4597
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-03
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC011349225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics