Provider Demographics
NPI:1689872558
Name:FREED, LAURA JO III
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:JO
Last Name:FREED
Suffix:III
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 1:250 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46122-1758
Mailing Address - Country:US
Mailing Address - Phone:317-745-6486
Mailing Address - Fax:
Practice Address - Street 1:255 MEADOW DR
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IN
Practice Address - Zip Code:46122-1415
Practice Address - Country:US
Practice Address - Phone:317-745-5451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31000 243A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist