Healthcare Provider Details

I. General information

NPI: 1083837587
Provider Name (Legal Business Name): LAUREN PRICE OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 NW 28TH ST
GAINESVILLE FL
32607-2511
US

IV. Provider business mailing address

24027 NW 3RD AVE
NEWBERRY FL
32669-2248
US

V. Phone/Fax

Practice location:
  • Phone: 352-246-5384
  • Fax: 352-376-0126
Mailing address:
  • Phone: 352-246-6797
  • Fax: 352-376-0126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT10854
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: