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Individual

LAURIE CONNOLLY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
OT

Contact information

Practice address
100 S I ST, STE 205, ABERDEEN, WA 98520-6502
(360) 532-1707
(360) 532-1703
Mailing address
100 S I ST, STE 205, ABERDEEN, WA 98520-6502
(360) 532-1707
(360) 532-1703

Taxonomy

Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
OT00001109
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0167363
L & I
WA
05
7681679
WA
01
GAB34664
MEDICARE PTAN
WA
Enumeration date
07/07/2006
Last updated
06/16/2016
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