Provider Demographics
NPI:1063685618
Name:SHEEHAN, LAUREN TAYLOR (OTD)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:TAYLOR
Last Name:SHEEHAN
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:TAYLOR
Other - Last Name:SHEEHAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTD
Mailing Address - Street 1:1000 8TH AVE APT 1-908
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-1169
Mailing Address - Country:US
Mailing Address - Phone:402-590-6816
Mailing Address - Fax:402-590-6816
Practice Address - Street 1:1000 8TH AVE APT 1-908
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-1169
Practice Address - Country:US
Practice Address - Phone:402-590-6816
Practice Address - Fax:402-590-6816
Is Sole Proprietor?:No
Enumeration Date:2008-04-03
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT60313973225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47043959902Medicaid