Provider Demographics
NPI:1801954862
Name:BAXLA, LAUREL L (OTRL)
Entity type:Individual
Prefix:
First Name:LAUREL
Middle Name:L
Last Name:BAXLA
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 SW 14TH ST
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-3215
Mailing Address - Country:US
Mailing Address - Phone:352-351-8300
Mailing Address - Fax:352-351-8310
Practice Address - Street 1:425 SW 14TH ST
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-3215
Practice Address - Country:US
Practice Address - Phone:352-351-8300
Practice Address - Fax:352-351-8310
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT-8330225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSG083062OtherVISTA HEALTHPLAN PROV #
FLPR77413160002OtherCIGNA PROVIDER #
FLZ0614OtherBCBS NON-PAR PROV #