Provider Demographics
NPI:1003238197
Name:ZACK, LAUREN (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:ZACK
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1555 E END BLVD
Mailing Address - Street 2:
Mailing Address - City:PLAINS TWP
Mailing Address - State:PA
Mailing Address - Zip Code:18702-7927
Mailing Address - Country:US
Mailing Address - Phone:570-408-8819
Mailing Address - Fax:570-822-6076
Practice Address - Street 1:1555 E END BLVD
Practice Address - Street 2:
Practice Address - City:PLAINS TWP
Practice Address - State:PA
Practice Address - Zip Code:18702-7927
Practice Address - Country:US
Practice Address - Phone:570-408-8819
Practice Address - Fax:570-822-6076
Is Sole Proprietor?:No
Enumeration Date:2014-01-09
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0C011910225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist