Provider Demographics
NPI:1841756012
Name:BRAM, LAURIE LOUISE (COTA)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:LOUISE
Last Name:BRAM
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2309 BERKELEY AVE APT 2111
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-4366
Mailing Address - Country:US
Mailing Address - Phone:512-501-0822
Mailing Address - Fax:
Practice Address - Street 1:1003 BECKETT STE 201
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78213-1372
Practice Address - Country:US
Practice Address - Phone:210-998-2330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-13
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX215493224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant