Provider Demographics
NPI:1508576604
Name:MITCHELL, LAUREN-RENAE (OTR)
Entity Type:Individual
Prefix:
First Name:LAUREN-RENAE
Middle Name:
Last Name:MITCHELL
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 1:11122 S VERNON AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60628-4627
Mailing Address - Country:US
Mailing Address - Phone:708-200-2414
Mailing Address - Fax:
Practice Address - Street 1:16300 WAUSAU AVE
Practice Address - Street 2:
Practice Address - City:SOUTH HOLLAND
Practice Address - State:IL
Practice Address - Zip Code:60473-2158
Practice Address - Country:US
Practice Address - Phone:708-596-5500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-29
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist