MEDICARE: MRS. LAUREN ELIZABETH RICCO 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	225XP0200X	Pediatric Occupational Therapist	016900	NY

General Provider Information

NPI Number	:	1457630964
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAUREN ELIZABETH RICCO OTR/L

Provider Business Mailing Address
First Line	:	16 INDIAN TRL
Second Line	:
City	:	MATAWAN
State	:	NJ
Zip	:	07747-2810
Country	:	US
Telephone Number	:	917-620-5455
Fax Number	:

Provider Business Practice Location Address
First Line	:	715 OCEAN TER
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10301-4542
Country	:	US
Telephone Number	:	718-390-1600
Fax Number	:

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

Provider Enumeration Date	:	08/15/2011
Last Update Date	:	05/08/2019

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