Provider Demographics
NPI:1578083796
Name:WEBER, LAURA MICHELLE (MOTR/L)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:MICHELLE
Last Name:WEBER
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:MISS
Other - First Name:LAURA
Other - Middle Name:MICHELLE
Other - Last Name:TEMPLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3131 STILLWELL DR
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59602-3008
Mailing Address - Country:US
Mailing Address - Phone:406-459-7934
Mailing Address - Fax:
Practice Address - Street 1:3131 STILLWELL DR
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59602-3008
Practice Address - Country:US
Practice Address - Phone:406-459-7934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-20
Last Update Date:2017-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTOTP-OT-LIC-3383225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist