Provider Demographics
NPI:1619233871
Name:DZICZKOWSKI, LAUREN (OTR/L)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:DZICZKOWSKI
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:K
Other - Last Name:FENSKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10055 ARCHER LN
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-7038
Mailing Address - Country:US
Mailing Address - Phone:614-309-0280
Mailing Address - Fax:
Practice Address - Street 1:6830 N HIGH ST
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-2582
Practice Address - Country:US
Practice Address - Phone:614-888-4553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-02
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT.007778225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist