Provider Demographics
NPI:1992165898
Name:ROPER, LAREN ALDEN JR (OTR/L)
Entity type:Individual
Prefix:MR
First Name:LAREN
Middle Name:ALDEN
Last Name:ROPER
Suffix:JR
Gender:M
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 1:1115 S COTTONWOOD
Mailing Address - Street 2:GREAT PLAINS SPORTS AND THERAPY CENTER
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101
Mailing Address - Country:US
Mailing Address - Phone:308-696-7456
Mailing Address - Fax:
Practice Address - Street 1:1115 S COTTONWOOD
Practice Address - Street 2:GREAT PLAINS SPORTS AND THERAPY CENTER
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101
Practice Address - Country:US
Practice Address - Phone:308-696-7456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-04
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE338225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist