Healthcare Provider Details

I. General information

NPI: 1376244046
Provider Name (Legal Business Name): LAUREN BLOSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2023
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 DANBURY RD STE 200
WILTON CT
06897-4405
US

IV. Provider business mailing address

18444 N 25TH AVE STE 310
PHOENIX AZ
85023-1266
US

V. Phone/Fax

Practice location:
  • Phone: 203-845-2987
  • Fax:
Mailing address:
  • Phone: 623-241-8741
  • Fax: 480-499-8459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number006175
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number6175
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: