Provider Demographics
NPI:1730375684
Name:LEVINE, LAURA NICOLE (OTR)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:NICOLE
Last Name:LEVINE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 JOHN MAHAR HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-5438
Mailing Address - Country:US
Mailing Address - Phone:413-519-2470
Mailing Address - Fax:
Practice Address - Street 1:501 JOHN MAHAR HWY
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-6599
Practice Address - Country:US
Practice Address - Phone:413-519-2470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA196784225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist