Healthcare Provider Details

I. General information

NPI: 1740015965
Provider Name (Legal Business Name): LAUREN BROWNELL MS, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAUREN HOWARD

II. Dates (important events)

Enumeration Date: 09/06/2024
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1161 E CLARK RD STE 360-A
DEWITT MI
48820-7930
US

IV. Provider business mailing address

8378 N COCHRAN RD
GRAND LEDGE MI
48837-9437
US

V. Phone/Fax

Practice location:
  • Phone: 517-507-5525
  • Fax:
Mailing address:
  • Phone: 989-553-5287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number5201014004
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: