Provider Demographics
NPI:1598409989
Name:LAUREN EDWARDS PELVIC HEALTH LLC
Entity Type:Organization
Organization Name:LAUREN EDWARDS PELVIC HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, OT/L
Authorized Official - Phone:805-440-1955
Mailing Address - Street 1:150 RALPH BECK LN
Mailing Address - Street 2:
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-2904
Mailing Address - Country:US
Mailing Address - Phone:805-850-8993
Mailing Address - Fax:805-980-4416
Practice Address - Street 1:3421 EMPRESA DR STE D
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-7364
Practice Address - Country:US
Practice Address - Phone:805-440-1955
Practice Address - Fax:805-980-4416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-22
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Single Specialty