Healthcare Provider Details

I. General information

NPI: 1659670602
Provider Name (Legal Business Name): LAUREN ELIZABETH REGEIMBAL M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAUREN BURDULIS

II. Dates (important events)

Enumeration Date: 03/16/2011
Last Update Date: 05/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

197 THOMAS JOHNSON DR STE B
FREDERICK MD
21702-4314
US

IV. Provider business mailing address

197 THOMAS JOHNSON DR STE B
FREDERICK MD
21702-4314
US

V. Phone/Fax

Practice location:
  • Phone: 301-662-1997
  • Fax:
Mailing address:
  • Phone: 301-662-1997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number07264
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number10298
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: