Healthcare Provider Details

I. General information

NPI: 1770105355
Provider Name (Legal Business Name): LAUREN LENNON OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2020
Last Update Date: 02/24/2026
Certification Date: 02/24/2026
Deactivation Date: 02/19/2026
Reactivation Date: 02/24/2026

III. Provider practice location address

23247 I 30 UNIT 7
BRYANT AR
72022-2571
US

IV. Provider business mailing address

914 AMY CIR
BRYANT AR
72022-4113
US

V. Phone/Fax

Practice location:
  • Phone: 501-313-0592
  • Fax:
Mailing address:
  • Phone: 501-249-4651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOTR4204
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: