Provider Demographics
NPI:1023619640
Name:BURKETT, LAUREN (MOT, OTR/L)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:BURKETT
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7102 HIGHWAY 175
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:LA
Mailing Address - Zip Code:71406-5106
Mailing Address - Country:US
Mailing Address - Phone:318-315-4339
Mailing Address - Fax:
Practice Address - Street 1:1605 STUBBS AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-5629
Practice Address - Country:US
Practice Address - Phone:318-388-8414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA324857225X00000X
225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist