Provider Demographics
NPI:1568629442
Name:ADKINS, LAUREN (MOT)
Entity Type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:
Last Name:ADKINS
Suffix:
Gender:F
Credentials:MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:781 SW 148TH AVE APT 1505
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33325-3094
Mailing Address - Country:US
Mailing Address - Phone:954-496-0442
Mailing Address - Fax:
Practice Address - Street 1:9508 GRIFFIN RD
Practice Address - Street 2:
Practice Address - City:COOPER CITY
Practice Address - State:FL
Practice Address - Zip Code:33328-3416
Practice Address - Country:US
Practice Address - Phone:954-689-0730
Practice Address - Fax:888-725-9013
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-19
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT11230222Q00000X, 252Y00000X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL889677100Medicaid