Healthcare Provider Details

I. General information

NPI: 1023410628
Provider Name (Legal Business Name): LAUREN O'CONNOR MILLER OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAUREN CATHERINE O'CONNOR OTR/L

II. Dates (important events)

Enumeration Date: 09/25/2014
Last Update Date: 12/18/2021
Certification Date: 12/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 PROVIDENCE RD SUITE 80
VIRGINIA BEACH VA
23464-4128
US

IV. Provider business mailing address

5301 PROVIDENCE RD SUITE 80
VIRGINIA BEACH VA
23464-4128
US

V. Phone/Fax

Practice location:
  • Phone: 757-467-4604
  • Fax: 757-467-2716
Mailing address:
  • Phone: 757-467-4604
  • Fax: 757-467-2716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0119007019
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number4366
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: