Provider Demographics
NPI:1104694546
Name:LAURENT, CHRISLINE (OTR/L)
Entity type:Individual
Prefix:
First Name:CHRISLINE
Middle Name:
Last Name:LAURENT
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 AYLESBURY CT
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34758-4298
Mailing Address - Country:US
Mailing Address - Phone:321-948-9919
Mailing Address - Fax:
Practice Address - Street 1:1500 SOUTHGATE DR
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34746-6593
Practice Address - Country:US
Practice Address - Phone:321-566-2480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-14
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT24771225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist