Provider Demographics
NPI:1831397959
Name:OLDENBURG, LAUREL LEE (OTR/L, CLT-LANA)
Entity type:Individual
Prefix:
First Name:LAUREL
Middle Name:LEE
Last Name:OLDENBURG
Suffix:
Gender:F
Credentials:OTR/L, CLT-LANA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4511 N 45TH ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98407-5003
Mailing Address - Country:US
Mailing Address - Phone:253-677-6675
Mailing Address - Fax:
Practice Address - Street 1:3615 S 23RD ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1331
Practice Address - Country:US
Practice Address - Phone:253-348-0066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2013-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00004512225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist