Provider Demographics
NPI:1518364918
Name:DONNELLY, LAUREN (OTL, MS)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:DONNELLY
Suffix:
Gender:F
Credentials:OTL, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1214 ALLAIRE RD APT M
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:NJ
Mailing Address - Zip Code:07762-2460
Mailing Address - Country:US
Mailing Address - Phone:609-462-8941
Mailing Address - Fax:
Practice Address - Street 1:1 PELICAN DR
Practice Address - Street 2:SUITE #5
Practice Address - City:BAYVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08721-1600
Practice Address - Country:US
Practice Address - Phone:877-407-3422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-01
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00671600225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation