Provider Demographics
NPI:1801418801
Name:MOYER, LAUREN ELYSE (MS, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:ELYSE
Last Name:MOYER
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:MISS
Other - First Name:LAUREN
Other - Middle Name:ELYSE
Other - Last Name:BREEDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:353 S WYOMISSING AVE
Mailing Address - Street 2:
Mailing Address - City:SHILLINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19607-2537
Mailing Address - Country:US
Mailing Address - Phone:717-793-7925
Mailing Address - Fax:
Practice Address - Street 1:1 VETERANS DR
Practice Address - Street 2:
Practice Address - City:SPRING CITY
Practice Address - State:PA
Practice Address - Zip Code:19475-1241
Practice Address - Country:US
Practice Address - Phone:610-948-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-12
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC016947225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist