Provider Demographics
NPI:1568616308
Name:BENSON, LAURA ANN (OTRL)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:ANN
Last Name:BENSON
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:ANN
Other - Last Name:TOMLINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6022 S LINDBERGH BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63123-7040
Mailing Address - Country:US
Mailing Address - Phone:314-845-7751
Mailing Address - Fax:314-845-7752
Practice Address - Street 1:6022 S LINDBERGH BLVD
Practice Address - Street 2:STE 100
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63123-7040
Practice Address - Country:US
Practice Address - Phone:314-845-7751
Practice Address - Fax:314-845-7752
Is Sole Proprietor?:No
Enumeration Date:2008-11-06
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008021480225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist