Provider Demographics
NPI:1811099427
Name:RIVET, LAUREN BRUNSON (LOTR CHT)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:BRUNSON
Last Name:RIVET
Suffix:
Gender:F
Credentials:LOTR CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5568 MAIN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791-4088
Mailing Address - Country:US
Mailing Address - Phone:225-654-4330
Mailing Address - Fax:225-286-4330
Practice Address - Street 1:5568 MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791-4088
Practice Address - Country:US
Practice Address - Phone:225-654-4330
Practice Address - Fax:225-286-4330
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-03
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAZ10055225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAZ10055OtherOT LIC NUMBER
LA4B345Medicare ID - Type UnspecifiedINDIVIDUAL
LAZ10055OtherOT LIC NUMBER