Provider Demographics
NPI:1174582514
Name:GADBERRY, LAURA JEAN (OT, CHT)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:JEAN
Last Name:GADBERRY
Suffix:
Gender:F
Credentials:OT, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 E INDIANTOWN RD
Mailing Address - Street 2:SUITE C-4
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33477-5062
Mailing Address - Country:US
Mailing Address - Phone:561-575-4770
Mailing Address - Fax:561-575-4522
Practice Address - Street 1:311 E INDIANTOWN RD
Practice Address - Street 2:SUITE C-4
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33477-5062
Practice Address - Country:US
Practice Address - Phone:561-575-4770
Practice Address - Fax:561-575-4522
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT7296225X00000X
1011100418225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Not Answered225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4335580001OtherPALMETTO
FLR5MOtherBCBS
FLR5MOtherBCBS