Provider Demographics
NPI:1003944240
Name:STODDART, LAUREN (OCCUPATIONAL THERP)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:STODDART
Suffix:
Gender:F
Credentials:OCCUPATIONAL THERP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 E. 24TH ST
Mailing Address - Street 2:P.O. BOX 4588
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77805-4588
Mailing Address - Country:US
Mailing Address - Phone:979-822-6467
Mailing Address - Fax:979-821-9448
Practice Address - Street 1:302 E 24TH ST
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77803-5303
Practice Address - Country:US
Practice Address - Phone:979-822-6467
Practice Address - Fax:979-821-9448
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107005225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX005330801Medicaid