Provider Demographics
NPI:1134435902
Name:VAVRA, LAUREN (MS OTR/L)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:VAVRA
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 S DODSON RD
Mailing Address - Street 2:APT. W3
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-7393
Mailing Address - Country:US
Mailing Address - Phone:501-317-7880
Mailing Address - Fax:
Practice Address - Street 1:500 TIGER BLVD
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-4208
Practice Address - Country:US
Practice Address - Phone:501-317-7880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-31
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT-1067225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics