Provider Demographics
NPI:1780920587
Name:WINTERS, LAURA MARIE (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:MARIE
Last Name:WINTERS
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:MARIE
Other - Last Name:COSTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:128 WILEY DR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-8429
Mailing Address - Country:US
Mailing Address - Phone:508-364-9148
Mailing Address - Fax:
Practice Address - Street 1:1075 US HIGHWAY 17 S
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-7628
Practice Address - Country:US
Practice Address - Phone:252-338-3975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-25
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10770225X00000X
NC11858225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist