Provider Demographics
NPI:1801153549
Name:DUBIN, LAURIE JILL (OTR/L)
Entity type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:JILL
Last Name:DUBIN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:
Other - Last Name:HOWARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:36 WEBSTER ROAD
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06877-4308
Mailing Address - Country:US
Mailing Address - Phone:203-431-4331
Mailing Address - Fax:
Practice Address - Street 1:36 WEBSTER ROAD
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:CT
Practice Address - Zip Code:06877-4308
Practice Address - Country:US
Practice Address - Phone:203-431-4331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-19
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000795225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation