MEDICARE: MISS LAUREN RACHEL WENGERD 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	OT009118	OH

General Provider Information

NPI Number	:	1356856264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS LAUREN RACHEL WENGERD OTR/L

Provider Business Mailing Address
First Line	:	1432 ELMWOOD AVE APT B
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43212-2759
Country	:	US
Telephone Number	:	330-464-9171
Fax Number	:

Provider Business Practice Location Address
First Line	:	1432 ELMWOOD AVE APT B
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43212-2759
Country	:	US
Telephone Number	:	330-464-9171
Fax Number	:

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

Provider Enumeration Date	:	12/14/2017
Last Update Date	:	12/14/2017

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