Provider Demographics
NPI:1861523151
Name:RUPPENTHAL, LAURA MARGARET (OTR CHT)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:MARGARET
Last Name:RUPPENTHAL
Suffix:
Gender:F
Credentials:OTR CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5798 HIGHLAND RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48327-1826
Mailing Address - Country:US
Mailing Address - Phone:248-724-4400
Mailing Address - Fax:248-724-4405
Practice Address - Street 1:1282 KIRTS BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-4890
Practice Address - Country:US
Practice Address - Phone:248-918-5560
Practice Address - Fax:248-918-5565
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201002188225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI6211028Medicare PIN
MIN69750043Medicare PIN