Provider Demographics
NPI:1902658180
Name:BROUGHER, LAUREN (OTD)
Entity Type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:
Last Name:BROUGHER
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7440 HIGHWAY 92
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-5235
Mailing Address - Country:US
Mailing Address - Phone:770-212-2170
Mailing Address - Fax:770-783-8639
Practice Address - Street 1:1150 GRIMES BRIDGE RD STE 300
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-3938
Practice Address - Country:US
Practice Address - Phone:770-212-2170
Practice Address - Fax:770-783-8639
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist