Provider Demographics
NPI:1568633238
Name:FERREIRA, LAURIE ANN (OT)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:ANN
Last Name:FERREIRA
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 1:5909 N 72ND AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85303-4705
Mailing Address - Country:US
Mailing Address - Phone:623-293-6808
Mailing Address - Fax:
Practice Address - Street 1:5909 N 72ND AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85303-4705
Practice Address - Country:US
Practice Address - Phone:623-293-6808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-20
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4105225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist