Provider Demographics
NPI:1790903789
Name:GRAYBILL, LAUREN SUE (OTR/L, CLT)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:SUE
Last Name:GRAYBILL
Suffix:
Gender:F
Credentials:OTR/L, CLT
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:SUE
Other - Last Name:SCHOLAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L, CLT
Mailing Address - Street 1:150 ROCK POINT DR STE A
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-7727
Mailing Address - Country:US
Mailing Address - Phone:970-764-0085
Mailing Address - Fax:970-828-7227
Practice Address - Street 1:150 ROCK POINT DR STE A
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-7727
Practice Address - Country:US
Practice Address - Phone:970-764-0085
Practice Address - Fax:970-828-7227
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X
FL1394174400000X
GAOT001394225X00000X
IDOT-1637225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0004389OtherOT LICENSE
IDOT-1637OtherOT LICENSE
IDOT-1637OtherOT LICENSE