Provider Demographics
NPI:1255631891
Name:EATON, LAURA JEAN (OTR/L)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:JEAN
Last Name:EATON
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 1:61 NOTTINGHAM WAY
Mailing Address - Street 2:
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-1726
Mailing Address - Country:US
Mailing Address - Phone:207-479-4099
Mailing Address - Fax:
Practice Address - Street 1:797 WILSON ST STE 2
Practice Address - Street 2:
Practice Address - City:BREWER
Practice Address - State:ME
Practice Address - Zip Code:04412-1003
Practice Address - Country:US
Practice Address - Phone:207-947-8493
Practice Address - Fax:207-990-4819
Is Sole Proprietor?:No
Enumeration Date:2010-10-29
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT1361225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics