Provider Demographics
NPI:1124328190
Name:MCGINNIS, LAURA E (MS OTRL)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:E
Last Name:MCGINNIS
Suffix:
Gender:F
Credentials:MS OTRL
Other - Prefix:MISS
Other - First Name:LAURA
Other - Middle Name:E
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:9900 MEREDITH GRADE RD
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:MI
Mailing Address - Zip Code:48625-7827
Mailing Address - Country:US
Mailing Address - Phone:989-539-6868
Mailing Address - Fax:
Practice Address - Street 1:1222 NORTH DR
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-3200
Practice Address - Country:US
Practice Address - Phone:989-772-2957
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-25
Last Update Date:2018-03-06
Deactivation Date:2018-02-21
Deactivation Code:
Reactivation Date:2018-03-06
Provider Licenses
StateLicense IDTaxonomies
MI5202006878224Z00000X
MI5201008200225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant