Provider Demographics
NPI:1780072850
Name:DAVID, LAURENE KRISCH (OTR/L)
Entity type:Individual
Prefix:
First Name:LAURENE
Middle Name:KRISCH
Last Name:DAVID
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:LAURENE
Other - Middle Name:
Other - Last Name:KRISCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:110 BROMLEY DR
Mailing Address - Street 2:
Mailing Address - City:EASTSOUND
Mailing Address - State:WA
Mailing Address - Zip Code:98245-9446
Mailing Address - Country:US
Mailing Address - Phone:360-350-3710
Mailing Address - Fax:
Practice Address - Street 1:110 BROMLEY DR
Practice Address - Street 2:
Practice Address - City:EASTSOUND
Practice Address - State:WA
Practice Address - Zip Code:98245-9446
Practice Address - Country:US
Practice Address - Phone:360-350-3710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-24
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3203171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator