Healthcare Provider Details

I. General information

NPI: 1043126378
Provider Name (Legal Business Name): LAUREN ASHLEY GOLDEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 4TH ST
HOLTON MI
49425-7536
US

IV. Provider business mailing address

2040 LAWNEL AVE
NORTON SHORES MI
49441-3646
US

V. Phone/Fax

Practice location:
  • Phone: 231-821-1700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number5201013976
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: