Provider Demographics
NPI:1487990586
Name:VORST, LAURA (COTA/L)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:VORST
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 1:1712 S ANHINGA LN
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33035-1060
Mailing Address - Country:US
Mailing Address - Phone:786-349-4564
Mailing Address - Fax:
Practice Address - Street 1:1712 S ANHINGA LN
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33035-1060
Practice Address - Country:US
Practice Address - Phone:786-349-4564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-17
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131000371224Z00000X
FLOTA 12216224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant