Provider Demographics
NPI:1134437882
Name:CORN, LAUREN A (COTA)
Entity type:Individual
Prefix:MISS
First Name:LAUREN
Middle Name:A
Last Name:CORN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8107 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-2231
Mailing Address - Country:US
Mailing Address - Phone:870-784-0821
Mailing Address - Fax:
Practice Address - Street 1:365 MCKNIGHT AVE
Practice Address - Street 2:
Practice Address - City:WEST FORK
Practice Address - State:AR
Practice Address - Zip Code:72774-3144
Practice Address - Country:US
Practice Address - Phone:479-839-3030
Practice Address - Fax:479-839-3045
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-15
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT-A611224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant