Individual
LAURIE M RICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.T.
Contact information
Practice address
3840 HULEN ST, HTN, CLIENT ACCOUNTING, FORT WORTH, TX 76107-7277
(817) 569-4395
(817) 569-4517
Mailing address
3840 HULEN ST, HTN, CLIENT ACCOUNTING, FORT WORTH, TX 76107-7277
(817) 569-4395
(817) 569-4517
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
110930
TX
225XP0200X
Pediatric Occupational Therapist
110930
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
159893001
—
TX
01
—
8T1853
BCBS
TX
Enumeration date
12/20/2006
Last updated
05/14/2010
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