Healthcare Provider Details

I. General information

NPI: 1154689404
Provider Name (Legal Business Name): LAUREN MICHELLE RICKER MOT, OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2012
Last Update Date: 02/01/2023
Certification Date: 02/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3840 HULEN ST
FORT WORTH TX
76107-7277
US

IV. Provider business mailing address

PO BOX 2603
FORT WORTH TX
76113-2603
US

V. Phone/Fax

Practice location:
  • Phone: 817-569-4039
  • Fax:
Mailing address:
  • Phone: 817-569-4039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number5201008062
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: