Provider Demographics
NPI:1881970994
Name:CARR, LAURIE J (LAURIE CARR)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:J
Last Name:CARR
Suffix:
Gender:F
Credentials:LAURIE CARR
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:J
Other - Last Name:CARR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAURIE CARR OTR/L
Mailing Address - Street 1:5365 LEDGESTONE LN
Mailing Address - Street 2:
Mailing Address - City:BREWERTON
Mailing Address - State:NY
Mailing Address - Zip Code:13029-9458
Mailing Address - Country:US
Mailing Address - Phone:315-288-4018
Mailing Address - Fax:
Practice Address - Street 1:450 DURSTON AVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-1105
Practice Address - Country:US
Practice Address - Phone:315-435-4570
Practice Address - Fax:315-435-6212
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-02
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007291-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist