Provider Demographics
NPI:1265991665
Name:WOOD, LAURA MICHELLE (OTR)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:MICHELLE
Last Name:WOOD
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3511 HEMINGWAY RD
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-6019
Mailing Address - Country:US
Mailing Address - Phone:540-589-4721
Mailing Address - Fax:
Practice Address - Street 1:3511 HEMINGWAY RD
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-6019
Practice Address - Country:US
Practice Address - Phone:540-589-4721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-15
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1972923720Medicaid