Provider Demographics
NPI:1679255293
Name:DESIR, LAURA WINCHELLE (OTR/L)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:WINCHELLE
Last Name:DESIR
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 ATTILIO CIR
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-2139
Mailing Address - Country:US
Mailing Address - Phone:508-308-5426
Mailing Address - Fax:
Practice Address - Street 1:65 WALNUT ST STE 580
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-2194
Practice Address - Country:US
Practice Address - Phone:781-489-3697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA13474225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty