Provider Demographics
NPI:1720554785
Name:ROTRAMEL, LAURIE ANN (COTA/L)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:ANN
Last Name:ROTRAMEL
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:MS
Other - First Name:LAURIE
Other - Middle Name:ANN
Other - Last Name:ROTRAMEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:COTA/L
Mailing Address - Street 1:916 BURBANK RD # IN
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-5023
Mailing Address - Country:US
Mailing Address - Phone:573-620-4576
Mailing Address - Fax:
Practice Address - Street 1:916 BURBANK RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-5023
Practice Address - Country:US
Practice Address - Phone:573-620-4576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-17
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32003120A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant