Provider Demographics
NPI:1275297392
Name:KOFFMAN, LAUREN MARIE (OTR)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:MARIE
Last Name:KOFFMAN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E BASSE RD APT 2424
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-8404
Mailing Address - Country:US
Mailing Address - Phone:406-461-1888
Mailing Address - Fax:
Practice Address - Street 1:300 E BASSE RD APT 2424
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-8404
Practice Address - Country:US
Practice Address - Phone:406-461-1888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-25
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX121956225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist