Provider Demographics
NPI:1568786598
Name:PRATER, LAURIE ANNE (OTR)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:ANNE
Last Name:PRATER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10415 MORADO CIR
Mailing Address - Street 2:BLDG. 3 SUITE 120
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-5696
Mailing Address - Country:US
Mailing Address - Phone:512-345-0700
Mailing Address - Fax:888-368-3534
Practice Address - Street 1:10415 MORADO CIR
Practice Address - Street 2:BLDG. 3 SUITE 120
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-5696
Practice Address - Country:US
Practice Address - Phone:512-345-0700
Practice Address - Fax:888-368-3534
Is Sole Proprietor?:No
Enumeration Date:2010-03-19
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111967225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist