Provider Demographics
NPI:1174155279
Name:CHANDLER, LAURA A (L-ATC, OTC)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:A
Last Name:CHANDLER
Suffix:
Gender:F
Credentials:L-ATC, OTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 BROADTURN RD
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-9729
Mailing Address - Country:US
Mailing Address - Phone:781-820-2404
Mailing Address - Fax:
Practice Address - Street 1:303 MAIN ST
Practice Address - Street 2:
Practice Address - City:CUMBERLAND CENTER
Practice Address - State:ME
Practice Address - Zip Code:04021-3958
Practice Address - Country:US
Practice Address - Phone:207-829-4805
Practice Address - Fax:207-829-2256
Is Sole Proprietor?:No
Enumeration Date:2020-02-06
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAT5692255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer