Provider Demographics
NPI:1023151339
Name:WILLIAMS, LAURA LEE (MA OTRL)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:LEE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MA OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3350 STAPLES PL
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-4536
Mailing Address - Country:US
Mailing Address - Phone:651-275-1383
Mailing Address - Fax:
Practice Address - Street 1:1705 COPE AVE E
Practice Address - Street 2:SUITE G
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-2639
Practice Address - Country:US
Practice Address - Phone:651-773-0354
Practice Address - Fax:651-773-0371
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN101383225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics