Provider Demographics
NPI:1467981233
Name:HAND CRAFTED THERAPY, PLLC
Entity Type:Organization
Organization Name:HAND CRAFTED THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:GRAYBILL
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L, CLT
Authorized Official - Phone:208-568-1983
Mailing Address - Street 1:PO BOX 822
Mailing Address - Street 2:
Mailing Address - City:SAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83860-0822
Mailing Address - Country:US
Mailing Address - Phone:208-568-1983
Mailing Address - Fax:208-568-1983
Practice Address - Street 1:606 N FIFTH AVE
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-1520
Practice Address - Country:US
Practice Address - Phone:208-568-1983
Practice Address - Fax:208-667-2119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-06
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0004389OtherOT LICENSE