Laura Anderson, OTR/L
Individual provider Active NPI Gerontology Occupational Therapist · Chuckey, TN
NPI 1386970044 · NPPES record last updated Oct 29, 2009
Key facts
- NPI
- 1386970044
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Gerontology Occupational Therapist 225XG0600X
- License
- 4038 (TN)
- Practice address
- 55 Nursing Home Rd
Chuckey, TN 37641-5579 - Phone
- (423) 257-6761
- NPI assigned
- Oct 29, 2009
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Occupational Therapist in Private Practice
- Education
- Other, 2009
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
2604 Hayslette Ave
Hurricane, WV 25526-1110
PO Box
Philadelphia, PA 19182
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WV
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260312001752 | WV | Practitioner - Occupational Therapist in Private Practice | 3870076334 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4038 | TN | MD | Physical Therapist |
| 1702 | WV | MD | Physical Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Powerback Rehabilitation LLC | Current |
Accepting new patients | |
| Powerback Rehabilitation LLC | Current |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gerontology Occupational Therapist | 225XG0600X | 4038 | TN | Yes |
Addresses
Primary practice location
55 Nursing Home Rd
Chuckey, TN 37641-5579
Mailing address
55 Nursing Home Rd
Chuckey, TN 37641-5579
Other providers in Chuckey, TN
All providers in Chuckey, TN · Gerontology Occupational Therapist in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 29, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.