Healthcare Provider Details

I. General information

NPI: 1841058963
Provider Name (Legal Business Name): LAUREN SKOVIRA MS, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2024
Last Update Date: 03/12/2024
Certification Date: 03/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 PARKERS LN
ALEXANDRIA VA
22306-3209
US

IV. Provider business mailing address

655 S WILLOW ST STE 128
MANCHESTER NH
03103-5723
US

V. Phone/Fax

Practice location:
  • Phone: 703-664-7834
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOC016099
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number16374
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT24865
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0119009940
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: