Provider Demographics
NPI:1982697488
Name:SERVID, LAURA (OT)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:
Last Name:SERVID
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1507 N 40TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-8137
Mailing Address - Country:US
Mailing Address - Phone:206-547-6033
Mailing Address - Fax:206-547-6033
Practice Address - Street 1:1507 N 40TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-8137
Practice Address - Country:US
Practice Address - Phone:206-547-6033
Practice Address - Fax:206-547-6033
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00000544225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WASE2924OtherBLUE CROSS
WASE2924OtherPREMERA
WASE2924OtherREGENCE
WA103625OtherWA STATE DEPT. LABOR/INDU
WAAB11876Medicare ID - Type Unspecified
WASE2924OtherREGENCE