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General NPI Number Information
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NPI Number | 1518535970
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Entity Type | Individual
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Provider Name | LAUREN MARIE PRUYNE OTR, OTD
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Gender | Female
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Dates
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Enumeration Date | 06/14/2021
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Last Update Date | 06/14/2021
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Provider Practice Location Address
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Address Line | 2001 PROFESSIONAL PKWY STE 220
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City | WOODSTOCK
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State | GA
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Zip | 30188-6444
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Country | US
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Telephone | 844-543-8437
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Fax | 844-471-3799
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Provider Business Mailing Address
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Address Line | 3755 REDWINE RD APT 6104
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City | EAST POINT
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State | GA
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Zip | 30344-5959
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Country | US
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Telephone | 570-419-8153
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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 |
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License Number State |
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