Provider Demographics
NPI:1811506553
Name:CHENOWETH, LAURA (OTR/L)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:CHENOWETH
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:KIRGISS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5150 WILDFLOWER DR
Mailing Address - Street 2:
Mailing Address - City:WHITESTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:46075-4551
Mailing Address - Country:US
Mailing Address - Phone:513-869-0641
Mailing Address - Fax:
Practice Address - Street 1:6825 MADISON AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-5168
Practice Address - Country:US
Practice Address - Phone:317-851-8419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-29
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31008595A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist