Provider Demographics
NPI:1902352313
Name:PATRICK, LAUREN BROOKE (OTR/L)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:BROOKE
Last Name:PATRICK
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 1:561 INWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-3586
Mailing Address - Country:US
Mailing Address - Phone:706-726-5795
Mailing Address - Fax:
Practice Address - Street 1:561 INWOOD TRL
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-3586
Practice Address - Country:US
Practice Address - Phone:706-726-5795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-27
Last Update Date:2016-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT005167225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist