Provider Demographics
NPI:1356193494
Name:DEAN, LAUREN GRANIER (OTR/L)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:GRANIER
Last Name:DEAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:LOUISE
Other - Last Name:GRANIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16635 CENTERFIELD DR STE 103
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-7745
Mailing Address - Country:US
Mailing Address - Phone:907-694-6002
Mailing Address - Fax:
Practice Address - Street 1:16635 CENTERFIELD DR STE 103
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-7745
Practice Address - Country:US
Practice Address - Phone:907-694-6002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-02
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK221534225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics