Provider Demographics
NPI:1922751171
Name:JEZEK, LAUREN SIMONIAN (COTA/L)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:SIMONIAN
Last Name:JEZEK
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:SIMONIAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:COTA/L
Mailing Address - Street 1:6508 BANBURY XING
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-8262
Mailing Address - Country:US
Mailing Address - Phone:901-210-7823
Mailing Address - Fax:
Practice Address - Street 1:6508 BANBURY XING
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-8262
Practice Address - Country:US
Practice Address - Phone:901-210-7823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-28
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2640225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist