Provider Demographics
NPI:1689023756
Name:GILLETT, LAUREN KELLY (OTR)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:KELLY
Last Name:GILLETT
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 N MACY ST
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-3326
Mailing Address - Country:US
Mailing Address - Phone:920-322-8546
Mailing Address - Fax:
Practice Address - Street 1:244 N MACY ST
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-3362
Practice Address - Country:US
Practice Address - Phone:920-322-8546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-08
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5740-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist