Provider Demographics
NPI:1487138731
Name:ANDERSON, LAUREN (COTA/L)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 SHOAL POINT CT APT 301
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32407-0405
Mailing Address - Country:US
Mailing Address - Phone:407-925-8658
Mailing Address - Fax:
Practice Address - Street 1:302 SHOAL POINT CT APT 301
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32407-0405
Practice Address - Country:US
Practice Address - Phone:407-925-8658
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-23
Last Update Date:2018-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant