Provider Demographics
NPI:1265418123
Name:BEAVER, LAURA A (OT)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:A
Last Name:BEAVER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:A
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:251 W CENTER ST
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-5900
Mailing Address - Country:US
Mailing Address - Phone:919-577-9200
Mailing Address - Fax:919-577-9292
Practice Address - Street 1:3001 EDWARDS MILL RD # 200
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-5243
Practice Address - Country:US
Practice Address - Phone:919-781-4060
Practice Address - Fax:919-781-5246
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2032225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist