Provider Demographics
NPI:1033457692
Name:DAVIS, LAUREN CONDON
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:CONDON
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 RIDGELAKE DR
Mailing Address - Street 2:SUITE 209
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-4966
Mailing Address - Country:US
Mailing Address - Phone:504-309-0868
Mailing Address - Fax:504-309-0867
Practice Address - Street 1:2901 RIDGELAKE DR
Practice Address - Street 2:SUITE 209
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-4966
Practice Address - Country:US
Practice Address - Phone:504-309-0868
Practice Address - Fax:504-309-0867
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAOTT.2200492225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist