| NPI | 1780920587 |
|---|---|
| Former Name | LAURA MARIE COSTIN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225XG0600X Occupational Therapist, Gerontology (Licence: NC 11858) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: MA 10770) |
| Enumeration Date | 2012-12-25 |
| Last Update Date | 2020-04-20 |