Provider Demographics
NPI:1578847166
Name:SOUDERS, LAUREN (MOTR/L, CBIS, CSRS)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:SOUDERS
Suffix:
Gender:F
Credentials:MOTR/L, CBIS, CSRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 BOBWHITE CIR
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-3108
Mailing Address - Country:US
Mailing Address - Phone:618-977-9426
Mailing Address - Fax:
Practice Address - Street 1:4455 DUNCAN AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1111
Practice Address - Country:US
Practice Address - Phone:314-658-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-01
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.009124225X00000X
MO2010027444225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist