Provider Demographics
NPI:1700231537
Name:O'CONNOR, LAURIE
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:O'CONNOR
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 1:11386 N LINDEN RD
Mailing Address - Street 2:SUITE A1
Mailing Address - City:CLIO
Mailing Address - State:MI
Mailing Address - Zip Code:48420-8501
Mailing Address - Country:US
Mailing Address - Phone:810-686-3123
Mailing Address - Fax:
Practice Address - Street 1:11386 N LINDEN RD
Practice Address - Street 2:SUITE A1
Practice Address - City:CLIO
Practice Address - State:MI
Practice Address - Zip Code:48420-8501
Practice Address - Country:US
Practice Address - Phone:810-686-3123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-29
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501003194225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist