Provider Demographics
NPI:1144531807
Name:REALE, LAUREN WHITNEY (OTR)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:WHITNEY
Last Name:REALE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 LAKE ST
Mailing Address - Street 2:APT # 2C
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10603-3851
Mailing Address - Country:US
Mailing Address - Phone:914-261-6473
Mailing Address - Fax:
Practice Address - Street 1:15 LAKE ST
Practice Address - Street 2:APT # 2C
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10603-3851
Practice Address - Country:US
Practice Address - Phone:914-261-6473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-28
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012750225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist