Provider Demographics
NPI:1528859378
Name:BOOHER, LAUREN WITZLER (COTA/L)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:WITZLER
Last Name:BOOHER
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5321 BEVERLY PARK CIR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37918-9253
Mailing Address - Country:US
Mailing Address - Phone:865-687-1321
Mailing Address - Fax:
Practice Address - Street 1:5321 BEVERLY PARK CIR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37918-9253
Practice Address - Country:US
Practice Address - Phone:865-687-1321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4242224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant