Provider Demographics
NPI:1386857241
Name:BACO, LAUREN (OTR L CHT)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:BACO
Suffix:
Gender:F
Credentials:OTR L CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26808 UNION TPKE
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11004-1351
Mailing Address - Country:US
Mailing Address - Phone:718-343-4263
Mailing Address - Fax:718-347-0738
Practice Address - Street 1:26808 UNION TPKE
Practice Address - Street 2:
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11004-1351
Practice Address - Country:US
Practice Address - Phone:718-343-4263
Practice Address - Fax:718-347-0738
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007144225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand