Provider Demographics
NPI:1124432174
Name:CHANEY, LAUREN (OTRL)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:CHANEY
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19552 PURNELL AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-2725
Mailing Address - Country:US
Mailing Address - Phone:440-241-2616
Mailing Address - Fax:216-901-2803
Practice Address - Street 1:997 W AURORA RD
Practice Address - Street 2:
Practice Address - City:SAGAMORE HILLS
Practice Address - State:OH
Practice Address - Zip Code:44067-4602
Practice Address - Country:US
Practice Address - Phone:330-468-2904
Practice Address - Fax:330-468-2905
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-18
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT007621225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH12713039OtherCAQH ACCOUNT