Provider Demographics
NPI:1417663121
Name:EDMISTON, LAUREN MARIE (OTR)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:MARIE
Last Name:EDMISTON
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 1:2 OAKWOOD PARK PLZ STE 200
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-1885
Mailing Address - Country:US
Mailing Address - Phone:720-788-7365
Mailing Address - Fax:720-294-0284
Practice Address - Street 1:2 OAKWOOD PARK PLZ STE 200
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-1885
Practice Address - Country:US
Practice Address - Phone:720-788-7365
Practice Address - Fax:720-294-0284
Is Sole Proprietor?:No
Enumeration Date:2023-01-26
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0007784225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist