Healthcare Provider Details

I. General information

NPI: 1578144176
Provider Name (Legal Business Name): LAUREN LA VALLE OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2021
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8685 W GRAND RIVER AVE
BRIGHTON MI
48116-2328
US

IV. Provider business mailing address

2122 YORK RD STE 300
OAK BROOK IL
60523-1925
US

V. Phone/Fax

Practice location:
  • Phone: 810-225-1187
  • Fax:
Mailing address:
  • Phone: 630-585-1980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number21678
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201013810
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: