Basic Information
| Provider Information | |||||||||
| NPI: | 1003434614 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FAVORITO | ||||||||
| FirstName: | LAUREN | ||||||||
| MiddleName: | ALANA | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | OT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3938 S TAMIAMI TRL | ||||||||
| Address2: | |||||||||
| City: | SARASOTA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342313622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8669891114 | ||||||||
| FaxNumber: | 8669891114 | ||||||||
| Practice Location | |||||||||
| Address1: | 3938 S TAMIAMI TRL | ||||||||
| Address2: | |||||||||
| City: | SARASOTA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342313622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8669891114 | ||||||||
| FaxNumber: | 8669891114 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2020 | ||||||||
| LastUpdateDate: | 07/09/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | OT18077 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.