Provider Demographics
NPI:1811659030
Name:KETTLEWELL, LAUREN MARIE (MOT, OTR/L)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:MARIE
Last Name:KETTLEWELL
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:MARIE
Other - Last Name:MCDOWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOT, OTR/L
Mailing Address - Street 1:111 VIRGINIA DRIVE
Mailing Address - Street 2:
Mailing Address - City:STEPHENS CITY
Mailing Address - State:VA
Mailing Address - Zip Code:22655
Mailing Address - Country:US
Mailing Address - Phone:540-664-1200
Mailing Address - Fax:
Practice Address - Street 1:120 BELLVIEW AVENUE
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601
Practice Address - Country:US
Practice Address - Phone:540-542-0200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst