Provider Demographics
NPI:1801567136
Name:MEIERDIERCK, LAUREN (OTR/L)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:MEIERDIERCK
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 WOODLAND AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNTAINSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07092-2523
Mailing Address - Country:US
Mailing Address - Phone:732-713-1541
Mailing Address - Fax:
Practice Address - Street 1:1433 HOOPER AVE STE 131
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-2238
Practice Address - Country:US
Practice Address - Phone:844-234-8387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-27
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR01002800225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist