Healthcare Provider Details

I. General information

NPI: 1457960288
Provider Name (Legal Business Name): LAUREN MILLER CROWDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2020
Last Update Date: 07/28/2020
Certification Date: 07/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

177 N HIGHLAND ST
MEMPHIS TN
38111-4747
US

IV. Provider business mailing address

1858 FELIX AVE
MEMPHIS TN
38114-1713
US

V. Phone/Fax

Practice location:
  • Phone: 901-251-9248
  • Fax:
Mailing address:
  • Phone: 901-619-7250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number6630
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: