Provider Demographics
NPI:1588430334
Name:PETERSON, LAUREN ASHLEY (OT, LAT)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:ASHLEY
Last Name:PETERSON
Suffix:
Gender:
Credentials:OT, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 S 26TH ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80904-3101
Mailing Address - Country:US
Mailing Address - Phone:619-219-1601
Mailing Address - Fax:
Practice Address - Street 1:14 E CACHE LA POUDRE ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-3243
Practice Address - Country:US
Practice Address - Phone:719-389-6488
Practice Address - Fax:719-389-6993
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-01
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00023972255A2300X
MD10419225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer