Provider Demographics
NPI:1962773739
Name:COLLINS, LAURA MARIE (SEIT)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:MARIE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:SEIT
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:MARIE
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SEIT
Mailing Address - Street 1:10868 DEPOT RD
Mailing Address - Street 2:
Mailing Address - City:REMSEN
Mailing Address - State:NY
Mailing Address - Zip Code:13438
Mailing Address - Country:US
Mailing Address - Phone:315-368-7316
Mailing Address - Fax:
Practice Address - Street 1:10868 DEPOT RD
Practice Address - Street 2:
Practice Address - City:REMSEN
Practice Address - State:NY
Practice Address - Zip Code:13438
Practice Address - Country:US
Practice Address - Phone:315-368-7316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-25
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist