Healthcare Provider Details

I. General information

NPI: 1417812975
Provider Name (Legal Business Name): LAUREN BLUME
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9880 HICKORY FLAT HWY
WOODSTOCK GA
30188-3081
US

IV. Provider business mailing address

1104 HAMPTON DR
SANDY SPRINGS GA
30350-3909
US

V. Phone/Fax

Practice location:
  • Phone: 770-687-2542
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: