Provider Demographics
NPI:1700499951
Name:FORD, LAURA L (MOTRL)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:L
Last Name:FORD
Suffix:
Gender:F
Credentials:MOTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4747 N HOLLAND SYLVANIA RD
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-2116
Mailing Address - Country:US
Mailing Address - Phone:419-824-8500
Mailing Address - Fax:
Practice Address - Street 1:4747 N HOLLAND SYLVANIA RD
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-2116
Practice Address - Country:US
Practice Address - Phone:419-824-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-27
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT010401225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist