Provider Demographics
NPI:1275631269
Name:SHOUN, LAURA LYNN (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:LYNN
Last Name:SHOUN
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 1:7604 NW 102ND ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73162-5311
Mailing Address - Country:US
Mailing Address - Phone:405-410-8814
Mailing Address - Fax:405-721-1882
Practice Address - Street 1:7604 NW 102ND ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73162-5311
Practice Address - Country:US
Practice Address - Phone:405-410-8814
Practice Address - Fax:405-721-1882
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKOT223225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100670140AMedicaid
OK100670140CMedicaid