Provider Demographics
NPI:1164894408
Name:KOEPKE, LAUREN (MT-BC)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:KOEPKE
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 KAKALA ST
Mailing Address - Street 2:#30
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-4549
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1210 WILHELMINA RISE
Practice Address - Street 2:UNIT B
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-3287
Practice Address - Country:US
Practice Address - Phone:480-226-6496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-27
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist