Healthcare Provider Details

I. General information

NPI: 1700740644
Provider Name (Legal Business Name): LAUREN MCCAUGHTRY OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAUREN MCCAUGHTRY PECK OTR/L

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16500 92ND AVE N
MAPLE GROVE MN
55311-5444
US

IV. Provider business mailing address

835 HOWELL ST N
SAINT PAUL MN
55104-1025
US

V. Phone/Fax

Practice location:
  • Phone: 763-493-5910
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number107730
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: