Provider Demographics
NPI:1255782728
Name:MONTEBELL, LAUREN (ATC)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:MONTEBELL
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:MRS
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:LACHANCE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ATC
Mailing Address - Street 1:2737 HUNTCLIFFE DR
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-0662
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2737 HUNTCLIFFE DR
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-0662
Practice Address - Country:US
Practice Address - Phone:724-664-9107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-27
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA20000064642255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer