Provider Demographics
NPI:1760485585
Name:COFFELT, LAUREEN MCLAREN (OT)
Entity type:Individual
Prefix:
First Name:LAUREEN
Middle Name:MCLAREN
Last Name:COFFELT
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6077 PRIMACY PKWY STE 140
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-5742
Mailing Address - Country:US
Mailing Address - Phone:901-725-8347
Mailing Address - Fax:901-259-7637
Practice Address - Street 1:6286 BRIARCREST AVE STE 200
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-4023
Practice Address - Country:US
Practice Address - Phone:901-641-3000
Practice Address - Fax:901-259-1698
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT-3879225XH1200X
TN1178225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3371161Medicaid
MS7187860Medicaid
TN620819926OtherCIGNA
MS620819926OtherBCBS
AR110318002Medicaid
AR158928721Medicaid
TN620819926OtherTRICARE
MS08031211Medicaid
TN7729581OtherAETNA
TN3645198Medicaid
TN4088730OtherBLUE CROSS
TN620819926OtherAETNA
TNP00281381OtherRAILROAD MEDICARE
MS08031211Medicaid
TNP00281381OtherRAILROAD MEDICARE