Provider Demographics
NPI:1669877833
Name:PRIEST, LAURA
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:PRIEST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18194 COUNTY ROAD 24
Mailing Address - Street 2:
Mailing Address - City:GROVER HILL
Mailing Address - State:OH
Mailing Address - Zip Code:45849-9505
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:813 N FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:VAN WERT
Practice Address - State:OH
Practice Address - Zip Code:45891-1303
Practice Address - Country:US
Practice Address - Phone:419-238-1514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-29
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA021224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant