Provider Demographics
NPI:1134473903
Name:MARTIN, LAURA NICOLE (MOT, LOTR)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:NICOLE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MOT, LOTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 JULIE LN
Mailing Address - Street 2:
Mailing Address - City:STONEWALL
Mailing Address - State:LA
Mailing Address - Zip Code:71078-9395
Mailing Address - Country:US
Mailing Address - Phone:318-393-6695
Mailing Address - Fax:
Practice Address - Street 1:240 JULIE LN
Practice Address - Street 2:
Practice Address - City:STONEWALL
Practice Address - State:LA
Practice Address - Zip Code:71078-9395
Practice Address - Country:US
Practice Address - Phone:318-393-6695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-01
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAOTT.200592225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist