Provider Demographics
NPI:1669007001
Name:LAU, VICTORIA (OTR)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:LAU
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 BEACH PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:FOSTER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94404-2707
Mailing Address - Country:US
Mailing Address - Phone:650-504-7681
Mailing Address - Fax:
Practice Address - Street 1:17670 NW 78TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33015-2707
Practice Address - Country:US
Practice Address - Phone:650-504-7681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-05
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
410936225X00000X
225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist