Provider Demographics
NPI:1780108829
Name:DEISENROTH, LAUREN P (MSOT, OTR/L)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:P
Last Name:DEISENROTH
Suffix:
Gender:F
Credentials:MSOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6505 DRAEBURY LN
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-6444
Mailing Address - Country:US
Mailing Address - Phone:919-260-2028
Mailing Address - Fax:
Practice Address - Street 1:1829 E FRANKLIN ST STE 600
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-5863
Practice Address - Country:US
Practice Address - Phone:919-968-3456
Practice Address - Fax:919-932-3456
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-31
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10554225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist