Provider Demographics
NPI:1447722319
Name:WESNER, LAUREN (MS, ATC, SCAT)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:WESNER
Suffix:
Gender:F
Credentials:MS, ATC, SCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 MYRTLE GREENS DR APT H
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-9048
Mailing Address - Country:US
Mailing Address - Phone:260-437-0294
Mailing Address - Fax:
Practice Address - Street 1:747 MILLERS RD
Practice Address - Street 2:
Practice Address - City:MULLINS
Practice Address - State:SC
Practice Address - Zip Code:29574-7228
Practice Address - Country:US
Practice Address - Phone:843-464-3710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC15152255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer