Healthcare Provider Details

I. General information

NPI: 1154993715
Provider Name (Legal Business Name): LAUREN HURT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2021
Last Update Date: 07/13/2021
Certification Date: 07/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19100 CRESCENT DR
MOKENA IL
60448-7510
US

IV. Provider business mailing address

17120 OVERHILL AVE
TINLEY PARK IL
60477-2648
US

V. Phone/Fax

Practice location:
  • Phone: 708-478-5400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056.014229
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: