Healthcare Provider Details

I. General information

NPI: 1437764560
Provider Name (Legal Business Name): LAUREN MARIE CHETWOOD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2020
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date: 03/17/2025
Reactivation Date: 04/23/2025

III. Provider practice location address

1031 AVENIDA PICO STE 201
SAN CLEMENTE CA
92673-6356
US

IV. Provider business mailing address

2883 RIACHUELO
SAN CLEMENTE CA
92673-4053
US

V. Phone/Fax

Practice location:
  • Phone: 949-388-8788
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT27511
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: