Provider Demographics
NPI:1811376221
Name:ATHAS, LAUREN (OTR/L)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:ATHAS
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 1:1110 GLENVIEW RD
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-3108
Mailing Address - Country:US
Mailing Address - Phone:847-641-0280
Mailing Address - Fax:
Practice Address - Street 1:6311 DEBARR RD
Practice Address - Street 2:#J
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-1787
Practice Address - Country:US
Practice Address - Phone:907-350-3840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-19
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2929225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist