Provider Demographics
NPI:1689125601
Name:WOODS, LAURA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:WOODS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 467
Mailing Address - Street 2:
Mailing Address - City:HAYTI
Mailing Address - State:MO
Mailing Address - Zip Code:63851-0467
Mailing Address - Country:US
Mailing Address - Phone:573-344-7713
Mailing Address - Fax:573-724-4611
Practice Address - Street 1:210 S 3RD ST
Practice Address - Street 2:
Practice Address - City:HAYTI
Practice Address - State:MO
Practice Address - Zip Code:63851-1618
Practice Address - Country:US
Practice Address - Phone:573-344-7713
Practice Address - Fax:573-724-4611
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-14
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services