Healthcare Provider Details

I. General information

NPI: 1134953565
Provider Name (Legal Business Name): LAUREN KELLY OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2024
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8147 E EVANS RD STE 8
SCOTTSDALE AZ
85260-3646
US

IV. Provider business mailing address

7305 E PLEASANT RUN
SCOTTSDALE AZ
85258-3104
US

V. Phone/Fax

Practice location:
  • Phone: 480-214-9725
  • Fax:
Mailing address:
  • Phone: 480-322-4131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XE0001X
TaxonomyEnvironmental Modification Occupational Therapist
License NumberOTH-007597
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License NumberOTH-007597
License Number StateAZ
# 4
Primary TaxonomyY
Taxonomy Code225XE1200X
TaxonomyErgonomics Occupational Therapist
License NumberOTH-007597
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: