1942787619 NPI number — MRS. LAURA M MILLIGAN OTR/L

Table of content: MRS. LAURA M MILLIGAN OTR/L (NPI 1942787619)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942787619 NPI number — MRS. LAURA M MILLIGAN OTR/L

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLIGAN
Provider First Name:
LAURA
Provider Middle Name:
M
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
OTR/L
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MILLIGAN
Provider Other First Name:
LAURA
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1942787619
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/25/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1405 S NEWBERRY LN APT A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TEMPE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85281-5995
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-250-8085
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
835 W WARNER RD STE 101-623
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GILBERT
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85233-0905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-416-4675
Provider Business Practice Location Address Fax Number:
480-584-4638
Provider Enumeration Date:
07/25/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  OTH-007543 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)