Provider Demographics
NPI:1912218397
Name:YANICK, LAURA E (OTR/L)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:E
Last Name:YANICK
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 1:756 BRIGHTON WAY
Mailing Address - Street 2:
Mailing Address - City:NEW HOPE
Mailing Address - State:PA
Mailing Address - Zip Code:18938-9547
Mailing Address - Country:US
Mailing Address - Phone:917-647-3939
Mailing Address - Fax:
Practice Address - Street 1:721 EMILY AVE
Practice Address - Street 2:
Practice Address - City:CROYDON
Practice Address - State:PA
Practice Address - Zip Code:19021-6725
Practice Address - Country:US
Practice Address - Phone:917-647-3939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-30
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC012591225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist