Provider Demographics
NPI:1134165608
Name:HOCTER-OUSLEY, LAURA L (DO)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:L
Last Name:HOCTER-OUSLEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5450 FRANTZ RD STE 360
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-4141
Mailing Address - Country:US
Mailing Address - Phone:614-544-6155
Mailing Address - Fax:614-544-6370
Practice Address - Street 1:24 W GREEN DR STE 246
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-2974
Practice Address - Country:US
Practice Address - Phone:740-593-2516
Practice Address - Fax:740-593-2905
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY02924207Q00000X
OH34007533207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810003420Medicaid
OH2280697Medicaid
KY64044845Medicaid
OH4063368Medicare PIN
KY0264276Medicare PIN
OH4161171Medicare PIN
OHP00356118Medicare PIN
KYP00649960Medicare PIN
WV3810003420Medicaid
KY0632967Medicare PIN
KY0351469Medicare PIN
H52626Medicare UPIN
OH4063367Medicare PIN
OH4063369Medicare PIN
KY0307671Medicare PIN