Healthcare Provider Details

I. General information

NPI: 1326670258
Provider Name (Legal Business Name): LAUREN EVELYN INTERIAL OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2020
Last Update Date: 05/16/2023
Certification Date: 05/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2051 45TH ST STE 201
WEST PALM BEACH FL
33407-2029
US

IV. Provider business mailing address

PO BOX 31473
PALM BEACH GARDENS FL
33420-1473
US

V. Phone/Fax

Practice location:
  • Phone: 561-632-0767
  • Fax: 561-630-6962
Mailing address:
  • Phone: 561-632-0767
  • Fax: 561-630-6962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT20666
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License NumberOT20666
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: