Basic Information
| Provider Information | |||||||||
| NPI: | 1326670258 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAVIS | ||||||||
| FirstName: | LAUREN | ||||||||
| MiddleName: | EVELYN | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4700 N CONGRESS AVE STE 100 | ||||||||
| Address2: | |||||||||
| City: | WEST PALM BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334073284 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5616320767 | ||||||||
| FaxNumber: | 5616306962 | ||||||||
| Practice Location | |||||||||
| Address1: | 4700 N CONGRESS AVE STE 100 | ||||||||
| Address2: | |||||||||
| City: | WEST PALM BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334073284 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5616320767 | ||||||||
| FaxNumber: | 5616306962 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2020 | ||||||||
| LastUpdateDate: | 03/11/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225XH1200X | OT20666 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Hand | 225X00000X | OT20666 | FL | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.