Provider Demographics
NPI:1891029153
Name:REDDY, LAURIE MICHELLE (OTR)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:MICHELLE
Last Name:REDDY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:MICHELLE
Other - Last Name:BURKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:1605 S KIRKWOOD RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-3158
Mailing Address - Country:US
Mailing Address - Phone:281-995-4075
Mailing Address - Fax:
Practice Address - Street 1:1605 S KIRKWOOD RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-3158
Practice Address - Country:US
Practice Address - Phone:281-995-4075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-18
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112045225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist