Provider Demographics
NPI:1598016453
Name:PEHLE, LAURA (OT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:PEHLE
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 1:3205 HURLEY WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95864-3853
Mailing Address - Country:US
Mailing Address - Phone:916-679-3108
Mailing Address - Fax:916-485-2653
Practice Address - Street 1:3205 HURLEY WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95864-3853
Practice Address - Country:US
Practice Address - Phone:916-485-6711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-01
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12929225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist