Provider Demographics
NPI:1215758834
Name:MATUKAITIS, LAUREN EMILY (OTR/L)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:EMILY
Last Name:MATUKAITIS
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 1:30 LACKEY RD
Mailing Address - Street 2:
Mailing Address - City:SUTTON
Mailing Address - State:MA
Mailing Address - Zip Code:01590-1628
Mailing Address - Country:US
Mailing Address - Phone:508-450-5220
Mailing Address - Fax:
Practice Address - Street 1:30 LACKEY RD
Practice Address - Street 2:
Practice Address - City:SUTTON
Practice Address - State:MA
Practice Address - Zip Code:01590-1628
Practice Address - Country:US
Practice Address - Phone:508-450-5220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-17
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15493225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist