Provider Demographics
NPI:1215051784
Name:CRIST, LAURA ANN (COTA)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:ANN
Last Name:CRIST
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:539 DARBY RD
Mailing Address - Street 2:
Mailing Address - City:RIDLEY PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19078-1316
Mailing Address - Country:US
Mailing Address - Phone:610-583-5355
Mailing Address - Fax:
Practice Address - Street 1:50 N MALIN RD
Practice Address - Street 2:
Practice Address - City:BROOMALL
Practice Address - State:PA
Practice Address - Zip Code:19008-1429
Practice Address - Country:US
Practice Address - Phone:610-356-4305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP005898224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant