Provider Demographics
NPI:1942787619
Name:MILLIGAN, LAURA M (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:M
Last Name:MILLIGAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:M
Other - Last Name:MILLIGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1405 S NEWBERRY LN APT A
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-5995
Mailing Address - Country:US
Mailing Address - Phone:480-250-8085
Mailing Address - Fax:
Practice Address - Street 1:835 W WARNER RD STE 101-623
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-0905
Practice Address - Country:US
Practice Address - Phone:480-416-4675
Practice Address - Fax:480-584-4638
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-25
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTH-007543225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist