Provider Demographics
NPI:1568698959
Name:GROSS, LAURIE S (OTR/L)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:S
Last Name:GROSS
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 1:1205 W LAURELTON PKWY
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-2752
Mailing Address - Country:US
Mailing Address - Phone:201-838-6525
Mailing Address - Fax:201-833-0484
Practice Address - Street 1:1205 W LAURELTON PKWY
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-2752
Practice Address - Country:US
Practice Address - Phone:201-838-6525
Practice Address - Fax:201-833-0484
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-31
Last Update Date:2009-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00024300225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist