Provider Demographics
NPI:1780957241
Name:RAYBURN, ELAYNE HALEY (OTR/L)
Entity type:Individual
Prefix:
First Name:ELAYNE
Middle Name:HALEY
Last Name:RAYBURN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:ELAYNE
Other - Middle Name:HALEY
Other - Last Name:VERVERIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1418 DEVENS DR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-7216
Mailing Address - Country:US
Mailing Address - Phone:615-221-4063
Mailing Address - Fax:
Practice Address - Street 1:1418 DEVENS DR
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-7216
Practice Address - Country:US
Practice Address - Phone:615-221-4063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-14
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOT0000004032225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist