Healthcare Provider Details

I. General information

NPI: 1073241931
Provider Name (Legal Business Name): LAUREN FERGUSON OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2022
Last Update Date: 08/09/2022
Certification Date: 08/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 FRANKLIN ST
NORTH ADAMS MA
01247-2799
US

IV. Provider business mailing address

1710 SHORT FARROW RD
HENDERSON TN
38340-7792
US

V. Phone/Fax

Practice location:
  • Phone: 413-664-4041
  • Fax:
Mailing address:
  • Phone: 731-225-4677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number4440
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number14498
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: