Provider Demographics
NPI:1336309087
Name:SPANG, LAUREN M (OTR)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:M
Last Name:SPANG
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:M
Other - Last Name:NISBET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:305 CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02458-1719
Mailing Address - Country:US
Mailing Address - Phone:617-244-8480
Mailing Address - Fax:617-244-8312
Practice Address - Street 1:305 CENTRE ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02458-1719
Practice Address - Country:US
Practice Address - Phone:617-244-8480
Practice Address - Fax:617-244-8312
Is Sole Proprietor?:No
Enumeration Date:2008-06-16
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9446225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist