Basic Information
Provider Information
NPI: 1174601181
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HIGDON
FirstName: LAUREN
MiddleName: JANE
NamePrefix: MRS.
NameSuffix:  
Credential: MS OTRL
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3030 NW EXPRESSWAY
Address2: SUITE 809
City: OKLAHOMA CITY
State: OK
PostalCode: 731125474
CountryCode: US
TelephoneNumber: 4059177160
FaxNumber: 8668488814
Practice Location
Address1: 3030 NW EXPRESSWAY
Address2: SUITE 809
City: OKLAHOMA CITY
State: OK
PostalCode: 731125474
CountryCode: US
TelephoneNumber: 4059177160
FaxNumber: 8668488814
Other Information
ProviderEnumerationDate: 11/01/2006
LastUpdateDate: 01/15/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225X00000X1302OKY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist 

No ID Information.


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