Provider Demographics
NPI:1700117645
Name:CORDELL, LAURA (MSA, OTR/L)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:
Last Name:CORDELL
Suffix:
Gender:F
Credentials:MSA, OTR/L
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:SIDELINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSA, OTR/L
Mailing Address - Street 1:100 SOMERBY DR
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-8780
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 SOMERBY DR
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-8780
Practice Address - Country:US
Practice Address - Phone:678-867-0200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-15
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT000782225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAOT000782OtherOCCUPATIONAL THERAPY LICENSE