Provider Demographics
NPI:1730412073
Name:SMITH, LAUREN CORINNE (OTR/L)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:CORINNE
Last Name:SMITH
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 WASHINGTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76701
Mailing Address - Country:US
Mailing Address - Phone:972-756-0500
Mailing Address - Fax:972-756-0448
Practice Address - Street 1:900 WASHINGTON AVENUE
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76701
Practice Address - Country:US
Practice Address - Phone:972-756-0500
Practice Address - Fax:972-756-0448
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-17
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 13771225XP0200X
TXTX-02138225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics