Provider Demographics
NPI:1285895904
Name:KAMINSKI, LAURA ELENA (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:ELENA
Last Name:KAMINSKI
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:ELENA
Other - Last Name:MORENO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 99283
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76199-1383
Mailing Address - Country:US
Mailing Address - Phone:682-885-6294
Mailing Address - Fax:682-885-1135
Practice Address - Street 1:1101 W VICKERY BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104
Practice Address - Country:US
Practice Address - Phone:682-885-6294
Practice Address - Fax:682-885-1135
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-25
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114869225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist