Provider Demographics
NPI:1457602096
Name:WOOLDRIDGE, LAURA SHALEA (OTR/ ATP)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:SHALEA
Last Name:WOOLDRIDGE
Suffix:
Gender:F
Credentials:OTR/ ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 N EDGEFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-3616
Mailing Address - Country:US
Mailing Address - Phone:972-814-6665
Mailing Address - Fax:
Practice Address - Street 1:701 N EDGEFIELD AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-3616
Practice Address - Country:US
Practice Address - Phone:972-814-6665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-23
Last Update Date:2012-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109985225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist