Provider Demographics
NPI:1720644263
Name:FITZPATRICK, LAURENE ELIZABETH (OTR)
Entity type:Individual
Prefix:
First Name:LAURENE
Middle Name:ELIZABETH
Last Name:FITZPATRICK
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:LAURENE
Other - Middle Name:ELIZABETH
Other - Last Name:MCCLURE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:4620 MINNESOTA AVE
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-5803
Mailing Address - Country:US
Mailing Address - Phone:916-832-4780
Mailing Address - Fax:
Practice Address - Street 1:3630 MISSION AVE
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-2933
Practice Address - Country:US
Practice Address - Phone:916-488-1580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-09
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4348225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology