Provider Demographics
NPI:1174794283
Name:HOTZ, LAURA K (OT)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:K
Last Name:HOTZ
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 1:1515 JONQUIL DR
Mailing Address - Street 2:
Mailing Address - City:WEBSTER GROVES
Mailing Address - State:MO
Mailing Address - Zip Code:63119-4644
Mailing Address - Country:US
Mailing Address - Phone:314-497-1180
Mailing Address - Fax:314-567-4505
Practice Address - Street 1:10560 OLD OLIVE STREET RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-5916
Practice Address - Country:US
Practice Address - Phone:314-567-4707
Practice Address - Fax:314-567-4505
Is Sole Proprietor?:No
Enumeration Date:2008-03-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004014840225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist