Provider Demographics
NPI:1801407812
Name:SNODGRASS, LAURA (OTR)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:SNODGRASS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 E HOLLAND AVE
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:TX
Mailing Address - Zip Code:79830-4830
Mailing Address - Country:US
Mailing Address - Phone:432-837-5907
Mailing Address - Fax:
Practice Address - Street 1:610 E HOLLAND AVE
Practice Address - Street 2:
Practice Address - City:ALPINE
Practice Address - State:TX
Practice Address - Zip Code:79830-4830
Practice Address - Country:US
Practice Address - Phone:432-837-5907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107899225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist