Provider Demographics
NPI:1386833416
Name:AEDER, LAURA DAVIDSON (MSOT)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:DAVIDSON
Last Name:AEDER
Suffix:
Gender:F
Credentials:MSOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12226 W UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32669-3001
Mailing Address - Country:US
Mailing Address - Phone:352-226-8386
Mailing Address - Fax:
Practice Address - Street 1:12226 W UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:FL
Practice Address - Zip Code:32669-3001
Practice Address - Country:US
Practice Address - Phone:352-226-8386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-15
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT12904225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics