Provider Demographics
NPI:1215278080
Name:IMBROSCIANO, LAURA (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:
Last Name:IMBROSCIANO
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 1:25 BREEZY HILL DR
Mailing Address - Street 2:
Mailing Address - City:FORT SALONGA
Mailing Address - State:NY
Mailing Address - Zip Code:11768-2614
Mailing Address - Country:US
Mailing Address - Phone:631-252-5725
Mailing Address - Fax:
Practice Address - Street 1:25 BREEZY HILL DR
Practice Address - Street 2:
Practice Address - City:FORT SALONGA
Practice Address - State:NY
Practice Address - Zip Code:11768-2614
Practice Address - Country:US
Practice Address - Phone:631-252-5725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-04
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011509-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist