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General NPI Number Information
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NPI Number | 1265843932
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Entity Type | Individual
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Provider Name | LAUREN KIENZL
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Gender | Female
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Dates
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Enumeration Date | 05/15/2014
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Last Update Date | 05/15/2014
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Provider Practice Location Address
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Address Line | 5535 S WILLIAMSON BLVD STE 774
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City | PORT ORANGE
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State | FL
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Zip | 32128-8311
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Country | US
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Telephone | 800-330-7711
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Fax |
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Provider Business Mailing Address
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Address Line | 835 KEY WEST DR
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City | PITTSBURGH
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State | PA
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Zip | 15239-2531
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 9195
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License Number State | NC
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