Provider Demographics
NPI:1568043511
Name:KOTVAL, LAUREN ELIZABETH (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:ELIZABETH
Last Name:KOTVAL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MRS
Other - First Name:LAUREN
Other - Middle Name:ELIZABETH
Other - Last Name:DEAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:4637 BREAKWATER WAY
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-6711
Mailing Address - Country:US
Mailing Address - Phone:404-432-5200
Mailing Address - Fax:
Practice Address - Street 1:1000 HOLCOMB WOODS PKWY STE 422
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-4718
Practice Address - Country:US
Practice Address - Phone:770-641-8070
Practice Address - Fax:770-641-8078
Is Sole Proprietor?:No
Enumeration Date:2021-04-20
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT008044225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist