Provider Demographics
NPI:1588849889
Name:RICHARDSON, LAURA LYNN (OTR)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:LYNN
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:LYNN
Other - Last Name:HOPPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:1175 NININGER ROAD
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:MN
Mailing Address - Zip Code:55033
Mailing Address - Country:US
Mailing Address - Phone:651-480-4435
Mailing Address - Fax:651-480-4339
Practice Address - Street 1:85 PLEASANT DRIVE
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:MN
Practice Address - Zip Code:55033
Practice Address - Country:US
Practice Address - Phone:651-480-4168
Practice Address - Fax:651-480-4339
Is Sole Proprietor?:No
Enumeration Date:2008-01-04
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN102737225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist