Provider Demographics
NPI:1689728578
Name:MCCRAINE, LAUREN L (LOTR)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:L
Last Name:MCCRAINE
Suffix:
Gender:F
Credentials:LOTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2002 JOHNSON ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:JENNINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70546-3640
Mailing Address - Country:US
Mailing Address - Phone:337-824-4547
Mailing Address - Fax:337-824-4548
Practice Address - Street 1:308 SIDNEY MARTIN RD
Practice Address - Street 2:ROOM 174
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70507-4544
Practice Address - Country:US
Practice Address - Phone:337-233-3665
Practice Address - Fax:337-233-3665
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAOTT200016225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4H324Medicare ID - Type Unspecified