Provider Demographics
NPI:1689316119
Name:EGUIA, LAURA (OTR/L)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:EGUIA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 LACEY DR
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07646-1049
Mailing Address - Country:US
Mailing Address - Phone:201-951-6686
Mailing Address - Fax:
Practice Address - Street 1:587 MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10044-0096
Practice Address - Country:US
Practice Address - Phone:212-223-5055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-13
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR01037600225X00000X
NY026520-01225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist