Provider Demographics
NPI:1942786470
Name:WINTERS, LAURA MARIE (OTR/L)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:MARIE
Last Name:WINTERS
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 1:451742 E 1065 RD
Mailing Address - Street 2:
Mailing Address - City:VIAN
Mailing Address - State:OK
Mailing Address - Zip Code:74962-6119
Mailing Address - Country:US
Mailing Address - Phone:479-244-5239
Mailing Address - Fax:
Practice Address - Street 1:1501 S WALDRON RD STE 107
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-2568
Practice Address - Country:US
Practice Address - Phone:479-226-3409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-18
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR230168721Medicaid