Provider Demographics
NPI:1619029816
Name:MEADOWS, LAURA (OTR, CHT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:MEADOWS
Suffix:
Gender:F
Credentials:OTR, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 BROOK RD
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95603-5363
Mailing Address - Country:US
Mailing Address - Phone:530-823-5279
Mailing Address - Fax:
Practice Address - Street 1:12055 PERSIMMON TER
Practice Address - Street 2:STE. 130
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-3808
Practice Address - Country:US
Practice Address - Phone:530-889-0478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 1632225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ31174ZMedicare ID - Type UnspecifiedMEDICARE PPIN
CAZZZ31174ZMedicare UPIN