Basic Information
| Provider Information | |||||||||
| NPI: | 1720644263 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FITZPATRICK | ||||||||
| FirstName: | LAURENE | ||||||||
| MiddleName: | ELIZABETH | ||||||||
| NamePrefix: | |||||||||
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| Credential: | OTR | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MCCLURE | ||||||||
| OtherFirstName: | LAURENE | ||||||||
| OtherMiddleName: | ELIZABETH | ||||||||
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| OtherCredential: | OTR | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 4620 MINNESOTA AVE | ||||||||
| Address2: | |||||||||
| City: | FAIR OAKS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956285803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9168324780 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3630 MISSION AVE | ||||||||
| Address2: | |||||||||
| City: | CARMICHAEL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956082933 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164881580 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2019 | ||||||||
| LastUpdateDate: | 05/09/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225XG0600X | 4348 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Gerontology |
No ID Information.