Healthcare Provider Details

I. General information

NPI: 1184313256
Provider Name (Legal Business Name): LAUREN DANIELLE CUNNINGHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2023
Last Update Date: 05/04/2023
Certification Date: 05/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

627 8TH ST
CLERMONT FL
34711-2159
US

IV. Provider business mailing address

1290 N RIDGE BLVD APT 211
CLERMONT FL
34711-2888
US

V. Phone/Fax

Practice location:
  • Phone: 352-243-4422
  • Fax:
Mailing address:
  • Phone: 352-988-4793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA18625
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: