Provider Demographics
NPI:1700040250
Name:TRIMBLE, LAUREN (OT)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:TRIMBLE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 WEDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-5414
Mailing Address - Country:US
Mailing Address - Phone:662-832-5188
Mailing Address - Fax:
Practice Address - Street 1:169 HIGHWAY 6 E
Practice Address - Street 2:SUITE 102
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-9415
Practice Address - Country:US
Practice Address - Phone:662-380-5030
Practice Address - Fax:662-380-5620
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-14
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119004512225X00000X
MSOT2247225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04833718Medicaid