Provider Demographics
NPI:1225749252
Name:PLOEG, LAUREN (OT)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:PLOEG
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2416 ELIZABETH ST
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:MI
Mailing Address - Zip Code:49120-7709
Mailing Address - Country:US
Mailing Address - Phone:269-313-2353
Mailing Address - Fax:
Practice Address - Street 1:4010 S IRONWOOD DR
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46614-2200
Practice Address - Country:US
Practice Address - Phone:574-291-2222
Practice Address - Fax:317-708-6496
Is Sole Proprietor?:No
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31007362A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist