Provider Demographics
NPI:1235552233
Name:AULT, LAUREN (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:
Last Name:AULT
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 WOLF ST
Mailing Address - Street 2:
Mailing Address - City:PEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:71964-9449
Mailing Address - Country:US
Mailing Address - Phone:501-760-7759
Mailing Address - Fax:501-760-7759
Practice Address - Street 1:205 WOLF ST
Practice Address - Street 2:
Practice Address - City:PEARCY
Practice Address - State:AR
Practice Address - Zip Code:71964-9449
Practice Address - Country:US
Practice Address - Phone:501-760-7759
Practice Address - Fax:501-760-7759
Is Sole Proprietor?:No
Enumeration Date:2014-01-27
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR2628225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR200278721Medicaid