Provider Demographics
NPI:1629622089
Name:MAYER, LAURA JUNE (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:JUNE
Last Name:MAYER
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4144 W 227TH ST
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW PARK
Mailing Address - State:OH
Mailing Address - Zip Code:44126-1831
Mailing Address - Country:US
Mailing Address - Phone:440-429-7500
Mailing Address - Fax:
Practice Address - Street 1:345 LEAR RD
Practice Address - Street 2:
Practice Address - City:AVON LAKE
Practice Address - State:OH
Practice Address - Zip Code:44012-2096
Practice Address - Country:US
Practice Address - Phone:440-930-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-24
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT010657225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist