Provider Demographics
NPI:1285697995
Name:ODLAND, LAURIE (PT,CHT)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:ODLAND
Suffix:
Gender:F
Credentials:PT,CHT
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:
Other - Last Name:LINHARDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:275 SW 160TH ST
Mailing Address - Street 2:STE. 201
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-3003
Mailing Address - Country:US
Mailing Address - Phone:206-244-4263
Mailing Address - Fax:206-244-8703
Practice Address - Street 1:275 SW 160TH ST
Practice Address - Street 2:STE. 201
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-3003
Practice Address - Country:US
Practice Address - Phone:206-244-4263
Practice Address - Fax:206-244-4287
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00002561225100000X, 2251H1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251H1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHand
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0111231OtherDEPT. OF LABOR&INDUSTRIES
WAA009OtherTRICARE
WAOD5372OtherREGENCE
WA8333080Medicaid
WA8931809OtherCRIME VICTUMS
WA8333080Medicaid