Provider Demographics
NPI:1245956812
Name:UBIENSKI, LAURA JEAN (COTA/L)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:JEAN
Last Name:UBIENSKI
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8798 COIT RD
Mailing Address - Street 2:
Mailing Address - City:RAVENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44266-9712
Mailing Address - Country:US
Mailing Address - Phone:330-780-7305
Mailing Address - Fax:
Practice Address - Street 1:531 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-2440
Practice Address - Country:US
Practice Address - Phone:330-297-4139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA007710224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant