Provider Demographics
NPI:1790126514
Name:FUTRELL, LAURA BEATTY JENNINGS (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:BEATTY JENNINGS
Last Name:FUTRELL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MISS
Other - First Name:LAURA
Other - Middle Name:BEATTY
Other - Last Name:JENNINGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:376 FRISCO WAY
Mailing Address - Street 2:
Mailing Address - City:HOLLY RIDGE
Mailing Address - State:NC
Mailing Address - Zip Code:28445-4202
Mailing Address - Country:US
Mailing Address - Phone:910-290-1534
Mailing Address - Fax:
Practice Address - Street 1:376 FRISCO WAY
Practice Address - Street 2:
Practice Address - City:HOLLY RIDGE
Practice Address - State:NC
Practice Address - Zip Code:28445-4202
Practice Address - Country:US
Practice Address - Phone:910-290-1534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-09
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9345225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist