Provider Demographics
NPI:1376180984
Name:ROBERTO, LAUREN ELISE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:ELISE
Last Name:ROBERTO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:LAUREN
Other - Middle Name:ELISE
Other - Last Name:OLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6906 WALDEMAR AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63139-3538
Mailing Address - Country:US
Mailing Address - Phone:224-688-7562
Mailing Address - Fax:
Practice Address - Street 1:801 N 11TH ST
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63101-1015
Practice Address - Country:US
Practice Address - Phone:314-231-3720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-02
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA13421225X00000X
MO2017030594225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA13421OtherOCCUPATIONAL THERAPIST