Provider Demographics
NPI:1205056926
Name:MORA, LAURA B (OT)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:B
Last Name:MORA
Suffix:
Gender:F
Credentials:OT
Other - Prefix:MRS
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:MORA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OT
Mailing Address - Street 1:1642 HARTLEY DR
Mailing Address - Street 2:
Mailing Address - City:SCHERERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46375-2200
Mailing Address - Country:US
Mailing Address - Phone:219-322-2037
Mailing Address - Fax:219-322-9787
Practice Address - Street 1:221US HIGHWAY 41
Practice Address - Street 2:SUITE G
Practice Address - City:SCHERERVILLE
Practice Address - State:IN
Practice Address - Zip Code:46375
Practice Address - Country:US
Practice Address - Phone:219-322-2037
Practice Address - Fax:219-322-9787
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31002534A225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics