Provider Demographics
NPI:1639683501
Name:MCMAHILL, LAURA (COTA/L)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:MCMAHILL
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:LAURA-BETH
Other - Middle Name:
Other - Last Name:RUSTVOLD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2976 MCHUGH AVE
Mailing Address - Street 2:
Mailing Address - City:ENUMCLAW
Mailing Address - State:WA
Mailing Address - Zip Code:98022-2340
Mailing Address - Country:US
Mailing Address - Phone:206-380-9714
Mailing Address - Fax:
Practice Address - Street 1:2976 MCHUGH AVE
Practice Address - Street 2:
Practice Address - City:ENUMCLAW
Practice Address - State:WA
Practice Address - Zip Code:98022-2340
Practice Address - Country:US
Practice Address - Phone:206-380-9714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-29
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60722658224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant