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General NPI Number Information
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NPI Number | 1689209165
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Entity Type | Individual
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Provider Name | LAUREN M. DAUTEL OTA
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Gender | Female
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Dates
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Enumeration Date | 03/05/2020
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Last Update Date | 03/05/2020
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Provider Practice Location Address
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Address Line | 480 BRAY CENTRAL DR
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City | ALLEN
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State | TX
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Zip | 75013-6418
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Country | US
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Telephone | 404-323-8430
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Fax |
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Provider Business Mailing Address
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Address Line | 1250 HUNT ST APT 3401
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City | RICHARDSON
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State | TX
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Zip | 75082-0033
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Country | US
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Telephone | 404-323-8430
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 216130
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License Number State | TX
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