Provider Demographics
NPI:1407432917
Name:BUZZARD, LAUREN (LMT, CMT)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:BUZZARD
Suffix:
Gender:F
Credentials:LMT, CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 PARK CIR APT 10
Mailing Address - Street 2:
Mailing Address - City:ASPEN
Mailing Address - State:CO
Mailing Address - Zip Code:81611-2428
Mailing Address - Country:US
Mailing Address - Phone:970-989-3333
Mailing Address - Fax:
Practice Address - Street 1:413 E MAIN ST # 206
Practice Address - Street 2:
Practice Address - City:ASPEN
Practice Address - State:CO
Practice Address - Zip Code:81611-1931
Practice Address - Country:US
Practice Address - Phone:970-989-3333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0023185225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist