Provider Demographics
NPI:1487054144
Name:STOUT, LAURIE B
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:B
Last Name:STOUT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:B
Other - Last Name:LESSIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:220 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19602-1804
Mailing Address - Country:US
Mailing Address - Phone:610-374-5175
Mailing Address - Fax:610-374-0426
Practice Address - Street 1:220 S 4TH ST
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19602-1804
Practice Address - Country:US
Practice Address - Phone:610-374-5175
Practice Address - Fax:610-374-0426
Is Sole Proprietor?:No
Enumeration Date:2014-09-01
Last Update Date:2014-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC011151225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist