Individual
LAUREN E ILLENCIK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ORT/L
Contact information
Practice address
5301 PROVIDENCE RD STE 80AND90, VIRGINIA BEACH, VA 23464-4128
(757) 467-4604
(757) 467-2716
Mailing address
1377 MOTOR PKWY STE 307, ISLANDIA, NY 11749-5258
(914) 294-4050
(631) 760-8306
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
009314
AZ
225X00000X
Occupational Therapist
Primary
0119008159
VA
Other
Enumeration date
04/06/2021
Last updated
04/28/2025
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