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General NPI Number Information
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NPI Number | 1639594690
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Entity Type | Individual
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Provider Name | LAUREN LAZENBY
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Gender | Female
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Dates
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Enumeration Date | 02/27/2014
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Last Update Date | 02/27/2014
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Provider Practice Location Address
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Address Line | 516 23RD AVE SE
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City | PUYALLUP
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State | WA
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Zip | 98372-4659
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Country | US
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Telephone | 253-292-9088
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Fax |
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Provider Business Mailing Address
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Address Line | 2002 LAFAYETTE ST UNIT 2
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City | STEILACOOM
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State | WA
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Zip | 98388-1351
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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 | 60441402
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License Number State | WA
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