Provider Demographics
NPI:1992412225
Name:KITZEL, LAUREN (OTD OTR/L)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:KITZEL
Suffix:
Gender:F
Credentials:OTD OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2214 AVENGALE DR
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97408-4800
Mailing Address - Country:US
Mailing Address - Phone:503-508-0697
Mailing Address - Fax:
Practice Address - Street 1:1 HAYDEN BRIDGE WAY
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-1347
Practice Address - Country:US
Practice Address - Phone:541-868-9430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR473905225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR473905OtherOREGON OCCUPATIONAL THERAPY LICENSE