Provider Demographics
NPI:1528260155
Name:KINGHAN, LAURA ANN (OT)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:ANN
Last Name:KINGHAN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:KROEPEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9150 W INDIAN SCHOOL RD STE 130
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-2388
Mailing Address - Country:US
Mailing Address - Phone:480-787-5387
Mailing Address - Fax:623-232-3250
Practice Address - Street 1:1016 W UNIVERSITY AVE STE 220
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-2997
Practice Address - Country:US
Practice Address - Phone:866-473-0264
Practice Address - Fax:866-473-0264
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0495225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ015249Medicaid
AZ015249Medicaid