Healthcare Provider Details

I. General information

NPI: 1710808258
Provider Name (Legal Business Name): LAUREN CHAMP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 ALBEMARLE SQ
CHARLOTTESVILLE VA
22901-7400
US

IV. Provider business mailing address

504 ALBEMARLE SQ
CHARLOTTESVILLE VA
22901-7405
US

V. Phone/Fax

Practice location:
  • Phone: 434-220-0021
  • Fax: 434-465-6843
Mailing address:
  • Phone: 434-817-7848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0119011514
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: