MEDICARE: MRS. LAUREN ELIZABETH ULLIMAN MOTR/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	225XP0200X	Pediatric Occupational Therapist
2	225X00000X	Occupational Therapist	2018031340	MO

General Provider Information

NPI Number	:	1194285957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAUREN ELIZABETH ULLIMAN MOTR/L

Provider Business Mailing Address
First Line	:	1575 LOUISVILLE AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63139-3630
Country	:	US
Telephone Number	:	618-409-1014
Fax Number	:

Provider Business Practice Location Address
First Line	:	1921 PRATHER AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63139-3546
Country	:	US
Telephone Number	:	314-645-1202
Fax Number	:

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

Provider Enumeration Date	:	03/20/2019
Last Update Date	:	09/07/2021

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