Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | OT11681 | FL |
NPI | 1760694582 |
---|---|
Provider Name | Lauren Raden |
First Address | Riverview, FL 33569 |
Second Address | Wauchula, FL 33873-8726 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2007 |
Last Update Date | 08/07/2007 |