Provider Demographics
NPI:1689877615
Name:OAKMAN, LAURA DENISE
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:DENISE
Last Name:OAKMAN
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 1:5936 TIMBERWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-8035
Mailing Address - Country:US
Mailing Address - Phone:336-924-9309
Mailing Address - Fax:
Practice Address - Street 1:4505 SHATTALON DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-2001
Practice Address - Country:US
Practice Address - Phone:336-924-9309
Practice Address - Fax:336-924-0388
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6058225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7211774Medicaid