Provider Demographics
NPI:1710295811
Name:MARTIN, LAURA SUE (OTL,LATS)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:SUE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:OTL,LATS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2241 NELSON DR
Mailing Address - Street 2:
Mailing Address - City:NISKAYUNA
Mailing Address - State:NY
Mailing Address - Zip Code:12309-3903
Mailing Address - Country:US
Mailing Address - Phone:518-377-9476
Mailing Address - Fax:
Practice Address - Street 1:2241 NELSON DR
Practice Address - Street 2:
Practice Address - City:NISKAYUNA
Practice Address - State:NY
Practice Address - Zip Code:12309-3903
Practice Address - Country:US
Practice Address - Phone:518-396-7537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-23
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004941225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist