Provider Demographics
NPI:1376718411
Name:MINTEN, LAUREN JUNE (OTR)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:JUNE
Last Name:MINTEN
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 1:6624 LONE OAK DR
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-9102
Mailing Address - Country:US
Mailing Address - Phone:414-534-1570
Mailing Address - Fax:
Practice Address - Street 1:6624 LONE OAK DR
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-9102
Practice Address - Country:US
Practice Address - Phone:920-918-7529
Practice Address - Fax:920-287-7247
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056008145225X00000X
WI4552-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41071400Medicaid