Provider Demographics
NPI:1942968979
Name:ELTZ, LAUREN ANN (COTA/L)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:ANN
Last Name:ELTZ
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:SLATINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:18080-1424
Mailing Address - Country:US
Mailing Address - Phone:484-330-1461
Mailing Address - Fax:
Practice Address - Street 1:1175 MOSSER RD
Practice Address - Street 2:
Practice Address - City:TREXLERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18087-9650
Practice Address - Country:US
Practice Address - Phone:610-395-5661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-07
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP010132224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant