Provider Demographics
NPI:1245255280
Name:PUTNAM, LAURANN MARIE (OTR/L)
Entity type:Individual
Prefix:
First Name:LAURANN
Middle Name:MARIE
Last Name:PUTNAM
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 1:114 ROYCE ST STE E
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95030-6041
Mailing Address - Country:US
Mailing Address - Phone:408-358-1460
Mailing Address - Fax:408-358-1459
Practice Address - Street 1:114 ROYCE ST STE E
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95030-6041
Practice Address - Country:US
Practice Address - Phone:408-358-1460
Practice Address - Fax:408-358-1459
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT1479225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGN859ZMedicare UPIN