Provider Demographics
NPI:1740670223
Name:HATLELI, LAURALEE VIRGINIA (MED, LAT, ATC, CEAS)
Entity type:Individual
Prefix:MRS
First Name:LAURALEE
Middle Name:VIRGINIA
Last Name:HATLELI
Suffix:
Gender:F
Credentials:MED, LAT, ATC, CEAS
Other - Prefix:MISS
Other - First Name:LAURALEE
Other - Middle Name:VIRGINIA
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, LAT, ATC
Mailing Address - Street 1:6428 BOWER DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46241-1861
Mailing Address - Country:US
Mailing Address - Phone:217-855-2757
Mailing Address - Fax:
Practice Address - Street 1:6428 BOWER DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46241-1861
Practice Address - Country:US
Practice Address - Phone:217-855-2757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-04
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36002460A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer