Provider Demographics
NPI:1912517665
Name:BASHOUR, LAURA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:BASHOUR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 STANLEY ST
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-9115
Mailing Address - Country:US
Mailing Address - Phone:304-319-1433
Mailing Address - Fax:
Practice Address - Street 1:105 STANLEY ST
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-9115
Practice Address - Country:US
Practice Address - Phone:304-319-1433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-07
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT20778225X00000X
SC5786225X00000X
WV1965225X00000X
VA0119008491225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist