Provider Demographics
NPI:1639670201
Name:BREINDEL, LAUREN R (COTA/L)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:R
Last Name:BREINDEL
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 CHERRY AVE
Mailing Address - Street 2:
Mailing Address - City:WEEDVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15868-3118
Mailing Address - Country:US
Mailing Address - Phone:814-389-3200
Mailing Address - Fax:
Practice Address - Street 1:765 JOHNSONBURG RD
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:PA
Practice Address - Zip Code:15857-3417
Practice Address - Country:US
Practice Address - Phone:814-834-2618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-28
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP009286224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant