Provider Demographics
NPI:1295598738
Name:GREIF, LAURA (LMT)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:GREIF
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:GREIF
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:304 ADAMS AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:LA GRANDE
Mailing Address - State:OR
Mailing Address - Zip Code:97850-1672
Mailing Address - Country:US
Mailing Address - Phone:208-695-3317
Mailing Address - Fax:
Practice Address - Street 1:304 ADAMS AVE APT 2
Practice Address - Street 2:
Practice Address - City:LA GRANDE
Practice Address - State:OR
Practice Address - Zip Code:97850-1672
Practice Address - Country:US
Practice Address - Phone:208-695-3317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
28001225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist