Healthcare Provider Details

I. General information

NPI: 1194285957
Provider Name (Legal Business Name): LAUREN ELIZABETH ULLIMAN MOTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2019
Last Update Date: 09/07/2021
Certification Date: 08/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1921 PRATHER AVE
SAINT LOUIS MO
63139-3546
US

IV. Provider business mailing address

1575 LOUISVILLE AVE
SAINT LOUIS MO
63139-3630
US

V. Phone/Fax

Practice location:
  • Phone: 314-645-1202
  • Fax:
Mailing address:
  • Phone: 618-409-1014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2018031340
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: