Provider Demographics
NPI:1316344146
Name:TYLER, LAUREN (ATC)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:TYLER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 STATE ST
Mailing Address - Street 2:APT 208
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169-7101
Mailing Address - Country:US
Mailing Address - Phone:978-793-2636
Mailing Address - Fax:
Practice Address - Street 1:800 STATE ST
Practice Address - Street 2:APT 208
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-7101
Practice Address - Country:US
Practice Address - Phone:978-793-2636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-21
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12342255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer