Basic Information
| Provider Information | |||||||||
| NPI: | 1588745731 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EALLONARDO | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | EVON | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MA, OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 22802 MARJORIE AVE | ||||||||
| Address2: | |||||||||
| City: | TORRANCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 905053450 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 812 W. TOWN & COUNTRY RD. | ||||||||
| Address2: | |||||||||
| City: | ORANGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928684712 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7145476494 | ||||||||
| FaxNumber: | 7145505285 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | OT3839 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.