Basic Information
| Provider Information | |||||||||
| NPI: | 1093067928 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JORDAN | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | REEVES | ||||||||
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| Credential: | OTR/L | ||||||||
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| OtherLastName: | REEVES | ||||||||
| OtherFirstName: | LAURA | ||||||||
| OtherMiddleName: | ALTA | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 4560 SE INTERNATIONAL WAY | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | MILWAUKIE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972224628 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9712065140 | ||||||||
| FaxNumber: | 9712065211 | ||||||||
| Practice Location | |||||||||
| Address1: | 2125 N OLIVE AVE | ||||||||
| Address2: | |||||||||
| City: | TURLOCK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953821947 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2092165648 | ||||||||
| FaxNumber: | 2096645625 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2012 | ||||||||
| LastUpdateDate: | 03/21/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 5826 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.