Provider Demographics
NPI:1972730091
Name:BEQUETTE, LAURA ANN (OD, OTR/L)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:ANN
Last Name:BEQUETTE
Suffix:
Gender:F
Credentials:OD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-1952
Mailing Address - Country:US
Mailing Address - Phone:636-937-2399
Mailing Address - Fax:366-937-4683
Practice Address - Street 1:223 MAIN ST
Practice Address - Street 2:
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-1952
Practice Address - Country:US
Practice Address - Phone:636-937-2399
Practice Address - Fax:366-937-4683
Is Sole Proprietor?:No
Enumeration Date:2009-06-16
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001015114225X00000X
MO2009032890152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1972730091Medicaid
MO1972730091Medicaid
MOMA5227035Medicare UPIN