Provider Demographics
NPI:1336578574
Name:RUBINCAN, LAUREN ELISE (COTA)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:ELISE
Last Name:RUBINCAN
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 1:412 MALLARD CIR
Mailing Address - Street 2:
Mailing Address - City:CLAYMONT
Mailing Address - State:DE
Mailing Address - Zip Code:19703-3117
Mailing Address - Country:US
Mailing Address - Phone:302-521-4438
Mailing Address - Fax:
Practice Address - Street 1:412 MALLARD CIR
Practice Address - Street 2:
Practice Address - City:CLAYMONT
Practice Address - State:DE
Practice Address - Zip Code:19703-3117
Practice Address - Country:US
Practice Address - Phone:302-521-4438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEU2-0001307224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant