Healthcare Provider Details

I. General information

NPI: 1023235637
Provider Name (Legal Business Name): LAUREN CAMILLE BUCHER OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 N 11TH ST MEDICAID DEPARTMENT
SAINT LOUIS MO
63101-1015
US

IV. Provider business mailing address

5552 LANSDOWNE AVE
SAINT LOUIS MO
63109-1659
US

V. Phone/Fax

Practice location:
  • Phone: 314-345-2535
  • Fax: 314-345-2653
Mailing address:
  • Phone: 314-353-7050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number2006013073
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: