Provider Demographics
NPI:1902000243
Name:POE, LAURA M (COTA)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:M
Last Name:POE
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 1:542 HUNTINGTON PKWY
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-5915
Mailing Address - Country:US
Mailing Address - Phone:615-833-3863
Mailing Address - Fax:
Practice Address - Street 1:2380 BUFFALO RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:TN
Practice Address - Zip Code:38464-4809
Practice Address - Country:US
Practice Address - Phone:931-762-9418
Practice Address - Fax:931-766-0563
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1087224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant