Healthcare Provider Details

I. General information

NPI: 1912811159
Provider Name (Legal Business Name): LAUREN GRACE AUGUSTYNOWICZ OTD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E STATE ST STE 302
MEDIA PA
19063-3434
US

IV. Provider business mailing address

306 WARE RD
NEWARK DE
19711-4364
US

V. Phone/Fax

Practice location:
  • Phone: 610-892-8767
  • Fax:
Mailing address:
  • Phone: 302-415-2111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberU1-0012900
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: