Provider Demographics
NPI:1982341020
Name:PORTEE, LAUREN YVONNE (OTR/L)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:YVONNE
Last Name:PORTEE
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 1:17442 AVENLEIGH DR
Mailing Address - Street 2:
Mailing Address - City:ASHTON
Mailing Address - State:MD
Mailing Address - Zip Code:20861-3626
Mailing Address - Country:US
Mailing Address - Phone:301-706-0121
Mailing Address - Fax:
Practice Address - Street 1:10714 BALTIMORE AVE
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-2112
Practice Address - Country:US
Practice Address - Phone:240-542-4420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-19
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD09662225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist