Provider Demographics
NPI:1942519590
Name:WIGGERS, LAURA MARIE (OTR/L)
Entity Type:Individual
Prefix:MISS
First Name:LAURA
Middle Name:MARIE
Last Name:WIGGERS
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:PO BOX 950
Mailing Address - Street 2:127 PARK ST.
Mailing Address - City:SHERMAN
Mailing Address - State:NY
Mailing Address - Zip Code:14781-0950
Mailing Address - Country:US
Mailing Address - Phone:716-761-6121
Mailing Address - Fax:716-761-6119
Practice Address - Street 1:127 PARK ST.
Practice Address - Street 2:SHERMAN CENTRAL SCHOOL
Practice Address - City:SHERMAN
Practice Address - State:NY
Practice Address - Zip Code:14781-0950
Practice Address - Country:US
Practice Address - Phone:716-761-6121
Practice Address - Fax:716-761-6119
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-30
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY63 016360225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist