Provider Demographics
NPI:1427784420
Name:HANCOCK, LAURIE MARIE (COMS)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:MARIE
Last Name:HANCOCK
Suffix:
Gender:F
Credentials:COMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 LAKEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LEAKESVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39451-3166
Mailing Address - Country:US
Mailing Address - Phone:601-394-2420
Mailing Address - Fax:601-440-2129
Practice Address - Street 1:575 LAKEWOOD DR
Practice Address - Street 2:
Practice Address - City:LEAKESVILLE
Practice Address - State:MS
Practice Address - Zip Code:39451-3166
Practice Address - Country:US
Practice Address - Phone:601-394-2420
Practice Address - Fax:601-440-2129
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-01
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS22205225CX0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225CX0006XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorOrientation and Mobility Training Provider