Active NPI
Laura Cadle Wall, OT
- Pediatric Occupational Therapist
- Grovetown, GA
National Provider Identifier
1033286679
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Occupational Therapist
- License
- OT003594
- Practice address
- 444 Park West Dr.
Grovetown, GA 30809 - Phone
- (706) 868-6543
- NPI assigned
- Nov 29, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Occupational Therapist | 225XP0200X | OT003594 | GA | Primary |
Addresses
Primary practice location
444 Park West Dr.
Grovetown, GA 30809
Mailing address
5003 Farmstone CT
Evans, GA 30809-6074
Phone (706) 651-9064
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OT003594 | GA | MD | Pediatric Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164758400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1033286679",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5003 FARMSTONE CT",
"city": "EVANS",
"state": "GA",
"postal_code": "308096074",
"telephone_number": "706-651-9064"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "444 PARK WEST DR.",
"city": "GROVETOWN",
"state": "GA",
"postal_code": "30809",
"telephone_number": "706-868-6543"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALL",
"first_name": "LAURA",
"middle_name": "CADLE",
"credential": "OT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-11-29",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "225XP0200X",
"taxonomy_group": "",
"desc": "Occupational Therapist, Pediatrics",
"state": "GA",
"license": "OT003594",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grovetown, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.