Provider Demographics
NPI:1255994554
Name:D'AMICO, LAURA (COTA/L)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:
Last Name:D'AMICO
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:578 JUNIPER AVE
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4429
Mailing Address - Country:US
Mailing Address - Phone:909-764-7989
Mailing Address - Fax:
Practice Address - Street 1:8135 PAINTER AVE STE 200
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90602-3168
Practice Address - Country:US
Practice Address - Phone:562-698-6600
Practice Address - Fax:562-698-6613
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-22
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA416467224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant