Provider Demographics
NPI:1376992842
Name:FEENEY, LAUREN
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:FEENEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14423 PRUNNINGWOOD PL
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-6238
Mailing Address - Country:US
Mailing Address - Phone:315-278-6474
Mailing Address - Fax:
Practice Address - Street 1:917 N PENNSYLVANIA AVE
Practice Address - Street 2:PREMAPLAY LLC
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-2456
Practice Address - Country:US
Practice Address - Phone:407-790-5601
Practice Address - Fax:407-602-7858
Is Sole Proprietor?:No
Enumeration Date:2016-06-06
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA14778224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOTA14778OtherSTATE OF FLORIDA DEPARTMENT OF HEALTH