Basic Information
| Provider Information | |||||||||
| NPI: | 1780108829 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEISENROTH | ||||||||
| FirstName: | LAUREN | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | MSOT, OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6505 DRAEBURY LN | ||||||||
| Address2: | |||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277136444 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9192602028 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1829 E FRANKLIN ST STE 600 | ||||||||
| Address2: | |||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275145863 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199683456 | ||||||||
| FaxNumber: | 9199323456 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2017 | ||||||||
| LastUpdateDate: | 12/07/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 10554 | NC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.