Healthcare Provider Details

I. General information

NPI: 1205756939
Provider Name (Legal Business Name): LAUREN GRACE STEVENS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4242 BRISTOW RD
BOWLING GREEN KY
42103-9526
US

IV. Provider business mailing address

4242 BRISTOW RD
BOWLING GREEN KY
42103-9526
US

V. Phone/Fax

Practice location:
  • Phone: 270-790-2664
  • Fax:
Mailing address:
  • Phone: 270-790-2664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number306873
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: