Provider Demographics
NPI:1992957153
Name:ROBERTSON, LAUREN (OT)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 PINEHURST AVE
Mailing Address - Street 2:A 14
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-1755
Mailing Address - Country:US
Mailing Address - Phone:212-923-7800
Mailing Address - Fax:
Practice Address - Street 1:116 PINEHURST AVE
Practice Address - Street 2:A 14
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-1755
Practice Address - Country:US
Practice Address - Phone:212-923-7800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004423-1225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics