Healthcare Provider Details

I. General information

NPI: 1760485585
Provider Name (Legal Business Name): LAUREEN MCLAREN COFFELT O.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 07/21/2021
Certification Date: 07/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6286 BRIARCREST AVE STE 200
MEMPHIS TN
38120-4023
US

IV. Provider business mailing address

6077 PRIMACY PKWY STE 140
MEMPHIS TN
38119-5742
US

V. Phone/Fax

Practice location:
  • Phone: 901-641-3000
  • Fax: 901-259-1698
Mailing address:
  • Phone: 901-725-8347
  • Fax: 901-259-7637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License NumberOT-3879
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number1178
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: