Provider Demographics
NPI:1760998470
Name:ANDERSON, LAUREN MAE (OTR/L)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:MAE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 36TH AVE SW STE B
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-7593
Mailing Address - Country:US
Mailing Address - Phone:701-837-9801
Mailing Address - Fax:701-425-0606
Practice Address - Street 1:2201 36TH AVE SW STE B
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-7593
Practice Address - Country:US
Practice Address - Phone:701-837-9801
Practice Address - Fax:701-425-0606
Is Sole Proprietor?:No
Enumeration Date:2017-12-18
Last Update Date:2017-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1589225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist