Provider Demographics
NPI:1861918898
Name:ANISCHKO, LAUREN SHERBUK (MSOT OTR/L)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:SHERBUK
Last Name:ANISCHKO
Suffix:
Gender:F
Credentials:MSOT OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10702 PRESERVE LAKE DR APT 107
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-4438
Mailing Address - Country:US
Mailing Address - Phone:727-418-2207
Mailing Address - Fax:
Practice Address - Street 1:4902 CREEKSIDE DR STE A
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33760-4033
Practice Address - Country:US
Practice Address - Phone:727-592-9100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-22
Last Update Date:2017-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18668225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist