Provider Demographics
NPI:1558489740
Name:URTZ, LAURA CABEZAS (OTR)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:CABEZAS
Last Name:URTZ
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 291537
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-0026
Mailing Address - Country:US
Mailing Address - Phone:803-419-5175
Mailing Address - Fax:803-419-5175
Practice Address - Street 1:1941 SAVAGE RD STE 400C
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-4791
Practice Address - Country:US
Practice Address - Phone:866-571-2700
Practice Address - Fax:866-571-2124
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3108225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist