Provider Demographics
NPI:1700231172
Name:GRUBAUGH, LAURA S (MS, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:S
Last Name:GRUBAUGH
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3803 COMPUTER DR
Mailing Address - Street 2:BUILDING B, SUITE 200
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-6541
Mailing Address - Country:US
Mailing Address - Phone:919-791-3582
Mailing Address - Fax:919-791-3583
Practice Address - Street 1:3803 COMPUTER DR
Practice Address - Street 2:BUILDING B, SUITE 200
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-6541
Practice Address - Country:US
Practice Address - Phone:919-791-3582
Practice Address - Fax:919-791-3583
Is Sole Proprietor?:No
Enumeration Date:2016-05-04
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10228225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist