Provider Demographics
NPI:1902930951
Name:SHAW, LAUREN NICOLE (MS OTRL)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:NICOLE
Last Name:SHAW
Suffix:
Gender:F
Credentials:MS OTRL
Other - Prefix:MISS
Other - First Name:LAUREN
Other - Middle Name:NICOLE
Other - Last Name:PEPPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS OTRL
Mailing Address - Street 1:313 KNOLLWOOD RD
Mailing Address - Street 2:
Mailing Address - City:MILLERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17551-9560
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:336 S WEST END AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-5043
Practice Address - Country:US
Practice Address - Phone:717-393-0419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC010045225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist