Provider Demographics
NPI:1508005174
Name:BURCH, LAUREN CASSIE (OTR/L)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:CASSIE
Last Name:BURCH
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1153 SWEETBRIAR ST
Mailing Address - Street 2:
Mailing Address - City:CANTONMENT
Mailing Address - State:FL
Mailing Address - Zip Code:32533-2925
Mailing Address - Country:US
Mailing Address - Phone:850-261-1864
Mailing Address - Fax:
Practice Address - Street 1:3932 N 10TH AVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2807
Practice Address - Country:US
Practice Address - Phone:850-434-7755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-05
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13479225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist