Provider Demographics
NPI:1578930046
Name:CARTER, LAUREN BETH (COTA)
Entity Type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:BETH
Last Name:CARTER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4370 E CAPPEL RD
Mailing Address - Street 2:
Mailing Address - City:MOSCOW MILLS
Mailing Address - State:MO
Mailing Address - Zip Code:63362-2118
Mailing Address - Country:US
Mailing Address - Phone:636-358-3729
Mailing Address - Fax:
Practice Address - Street 1:4370 E CAPPEL RD
Practice Address - Street 2:
Practice Address - City:MOSCOW MILLS
Practice Address - State:MO
Practice Address - Zip Code:63362-2118
Practice Address - Country:US
Practice Address - Phone:636-358-3729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-31
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDOTA-1410224Z00000X
IA077884224Z00000X
MO2010018661224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant