Provider Demographics
NPI:1689209165
Name:DAUTEL, LAUREN M (OTA)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:M
Last Name:DAUTEL
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 HUNT ST APT 3401
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-0033
Mailing Address - Country:US
Mailing Address - Phone:404-323-8430
Mailing Address - Fax:
Practice Address - Street 1:480 BRAY CENTRAL DR
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-6418
Practice Address - Country:US
Practice Address - Phone:404-323-8430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-05
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX216130224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant