Provider Demographics
NPI:1184954844
Name:SHELTON, LAUREN KOMOROUS (MOTR/L)
Entity type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:KOMOROUS
Last Name:SHELTON
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:MISS
Other - First Name:LAUREN
Other - Middle Name:ELIZABETH
Other - Last Name:KOMOROUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOTR/L
Mailing Address - Street 1:29 COUNTRY CLUB DR SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98498-5303
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:29 COUNTRY CLUB DR SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98498-5303
Practice Address - Country:US
Practice Address - Phone:253-691-3791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-31
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT60098299225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist