Lauren Brock, OTR/L
Individual provider Active NPI Occupational Therapist · Bogard, MO
NPI 1477035087 · NPPES record last updated Aug 30, 2018
Key facts
- NPI
- 1477035087
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapist 225X00000X
- License
- 2017035789 (MO)
- Practice address
- 108 N Main St
Bogard, MO 64622-7124 - Phone
- (660) 973-3074
- NPI assigned
- Aug 30, 2018
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2017035789 | MO | MD | Occupational Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 2017035789 | MO | Yes |
Addresses
Primary practice location
108 N Main St
Bogard, MO 64622-7124
Mailing address
108 N Main St
Bogard, MO 64622-7124
Phone (660) 973-3074
Other providers in Bogard, MO
All providers in Bogard, MO · Occupational Therapist in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 30, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.