MEDICARE: CHRISLINE LAURENT OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	OT24771	FL

General Provider Information

NPI Number	:	1104694546
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISLINE LAURENT OTR/L

Provider Business Mailing Address
First Line	:	370 AYLESBURY CT
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34758-4298
Country	:	US
Telephone Number	:	321-948-9919
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 SOUTHGATE DR
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34746-6593
Country	:	US
Telephone Number	:	321-566-2480
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/14/2023
Last Update Date	:	12/14/2023

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Directions to “ CHRISLINE LAURENT OTR/L” Practice Location

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