Provider Demographics
NPI:1083022701
Name:OBROCHTA, LAUREN N
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:N
Last Name:OBROCHTA
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 1:54 W COUNTRYSIDE PKWY
Mailing Address - Street 2:
Mailing Address - City:YORKVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60560-1959
Mailing Address - Country:US
Mailing Address - Phone:630-553-8393
Mailing Address - Fax:
Practice Address - Street 1:54 W COUNTRYSIDE PKWY
Practice Address - Street 2:
Practice Address - City:YORKVILLE
Practice Address - State:IL
Practice Address - Zip Code:60560-1959
Practice Address - Country:US
Practice Address - Phone:630-553-8393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-25
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227016130225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist