Provider Demographics
NPI:1144368259
Name:LANGSTON, LAURA MICHELLE (OTR)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:MICHELLE
Last Name:LANGSTON
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 1:3965 75TH ST STE 104
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-7913
Mailing Address - Country:US
Mailing Address - Phone:630-236-7000
Mailing Address - Fax:630-236-7800
Practice Address - Street 1:3965 75TH ST STE 104
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-7913
Practice Address - Country:US
Practice Address - Phone:630-236-7000
Practice Address - Fax:630-236-7800
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist