Provider Demographics
NPI:1225523657
Name:HALL, LAUREN ELISE (OTD, OTR)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:ELISE
Last Name:HALL
Suffix:
Gender:F
Credentials:OTD, OTR
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:ELISE
Other - Last Name:ROGEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7647 W CROCUS DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-8518
Mailing Address - Country:US
Mailing Address - Phone:623-606-0883
Mailing Address - Fax:
Practice Address - Street 1:1045 WHIPPLE ST
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-1662
Practice Address - Country:US
Practice Address - Phone:928-777-9897
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-27
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist