Provider Demographics
NPI:1447481551
Name:SPONSELLER, LAUREN N (COTA)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:N
Last Name:SPONSELLER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7862 RAGLAN DR NE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-1437
Mailing Address - Country:US
Mailing Address - Phone:330-984-8456
Mailing Address - Fax:
Practice Address - Street 1:563 COLONY PARK DR
Practice Address - Street 2:
Practice Address - City:TALLMADGE
Practice Address - State:OH
Practice Address - Zip Code:44278-2859
Practice Address - Country:US
Practice Address - Phone:330-630-9780
Practice Address - Fax:330-634-9560
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-06
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3424224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant