Provider Demographics
NPI:1861773392
Name:MACDONALD, LAUREN ANNE (OTR)
Entity type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:ANNE
Last Name:MACDONALD
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 1:48 DEER HAVEN DR
Mailing Address - Street 2:
Mailing Address - City:RENSSELAER
Mailing Address - State:NY
Mailing Address - Zip Code:12144-9739
Mailing Address - Country:US
Mailing Address - Phone:518-286-3147
Mailing Address - Fax:
Practice Address - Street 1:48 DEER HAVEN DR
Practice Address - Street 2:
Practice Address - City:RENSSELAER
Practice Address - State:NY
Practice Address - Zip Code:12144-9739
Practice Address - Country:US
Practice Address - Phone:518-286-3147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-29
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003889-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist