Healthcare Provider Details

I. General information

NPI: 1376858340
Provider Name (Legal Business Name): LAUREN MICHELE COUTTS MOT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2010
Last Update Date: 06/07/2024
Certification Date: 06/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9508 GRIFFIN RD
COOPER CITY FL
33328-3416
US

IV. Provider business mailing address

11237 NW 65TH CT
PARKLAND FL
33076-3709
US

V. Phone/Fax

Practice location:
  • Phone: 954-689-0730
  • Fax: 888-725-9013
Mailing address:
  • Phone: 954-263-3936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTT14228
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: