Healthcare Provider Details

I. General information

NPI: 1194443382
Provider Name (Legal Business Name): LAUREN OTT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2022
Last Update Date: 08/15/2022
Certification Date: 08/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78 WINDERMERE ROAD LONDON
LONDON ENGLAND
W5 4TD
GB

IV. Provider business mailing address

78 WINDERMERE ROAD
LONDON ENGLAND
W5 4TD
GB

V. Phone/Fax

Practice location:
  • Phone: 816-514-2357
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number14281602
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: