Provider Demographics
NPI:1205320066
Name:BICKNELL, LAUREN PATRICIA (MOT, OTR/L)
Entity type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:PATRICIA
Last Name:BICKNELL
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 CLAY RD
Mailing Address - Street 2:
Mailing Address - City:GORHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04038-2000
Mailing Address - Country:US
Mailing Address - Phone:818-917-0601
Mailing Address - Fax:
Practice Address - Street 1:39 LIMERICK RD
Practice Address - Street 2:
Practice Address - City:ARUNDEL
Practice Address - State:ME
Practice Address - Zip Code:04046-8158
Practice Address - Country:US
Practice Address - Phone:207-735-8749
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-15
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT3485225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist