Provider Demographics
NPI:1073326740
Name:QUESENBERRY, LAUREN KATHERINE (COTA)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:KATHERINE
Last Name:QUESENBERRY
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3865 STATE ROAD V
Mailing Address - Street 2:
Mailing Address - City:DE SOTO
Mailing Address - State:MO
Mailing Address - Zip Code:63020-5176
Mailing Address - Country:US
Mailing Address - Phone:803-356-2352
Mailing Address - Fax:
Practice Address - Street 1:704 E HIGHWAY 72
Practice Address - Street 2:
Practice Address - City:FREDERICKTOWN
Practice Address - State:MO
Practice Address - Zip Code:63645-7491
Practice Address - Country:US
Practice Address - Phone:573-783-8001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-28
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020028530224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant