Provider Demographics
NPI:1417173568
Name:GRIFFIN, LAURA MARTHA (MS, ATR-BC)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:MARTHA
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:MS, ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3908 N 46TH ST
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53083-2546
Mailing Address - Country:US
Mailing Address - Phone:920-458-1675
Mailing Address - Fax:
Practice Address - Street 1:1305 SAINT CLAIR AVE
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-3233
Practice Address - Country:US
Practice Address - Phone:920-458-8261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI54-036221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist