Provider Demographics
NPI:1629414248
Name:LAU, HAZEL (MOT; OTR/L)
Entity Type:Individual
Prefix:MS
First Name:HAZEL
Middle Name:
Last Name:LAU
Suffix:
Gender:F
Credentials:MOT; OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 BARNEGATE BAY
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94502-6477
Mailing Address - Country:US
Mailing Address - Phone:510-523-7081
Mailing Address - Fax:
Practice Address - Street 1:12 BARNEGATE BAY
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94502-6477
Practice Address - Country:US
Practice Address - Phone:510-523-7081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-22
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT688225X00000X, 225XE1200X, 225XL0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XE1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistErgonomics
No225XL0004XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistLow Vision