Provider Demographics
NPI:1063991644
Name:RIELS, LAUREN ASHLEY (OTR/L)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:ASHLEY
Last Name:RIELS
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 1:10150 GROTE RD
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:TX
Mailing Address - Zip Code:77835-7030
Mailing Address - Country:US
Mailing Address - Phone:601-466-2779
Mailing Address - Fax:
Practice Address - Street 1:400 E SAYLES ST
Practice Address - Street 2:
Practice Address - City:BRENHAM
Practice Address - State:TX
Practice Address - Zip Code:77833-2358
Practice Address - Country:US
Practice Address - Phone:979-836-9770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT15386225X00000X
TX115438225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX115438OtherOCCUPATIONAL THERAPY LICENSE
FLOT15386OtherOCCUPATIONAL THERAPY LICENSE