Provider Demographics
NPI:1750314431
Name:MICHAELS, LAURA A (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:A
Last Name:MICHAELS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 S FAIRMONT AVE
Mailing Address - Street 2:STE G
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95240-3860
Mailing Address - Country:US
Mailing Address - Phone:209-339-1690
Mailing Address - Fax:209-339-1693
Practice Address - Street 1:525 S FAIRMONT AVE
Practice Address - Street 2:STE G
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-3860
Practice Address - Country:US
Practice Address - Phone:209-339-1690
Practice Address - Fax:209-339-1693
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT3033225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA68-0192025OtherTIN
CA68-0192025OtherTIN