Provider Demographics
NPI:1811567415
Name:MCSPEDON, LAURA (OTR/L)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:MCSPEDON
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 1:290 S BUCKHOUT ST
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:10533-2206
Mailing Address - Country:US
Mailing Address - Phone:413-695-7517
Mailing Address - Fax:
Practice Address - Street 1:290 S BUCKHOUT ST
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NY
Practice Address - Zip Code:10533-2206
Practice Address - Country:US
Practice Address - Phone:413-695-7517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-28
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024718225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist