Provider Demographics
NPI:1679698989
Name:GRAVES, LAURA ANN (OTR)
Entity type:Individual
Prefix:MISS
First Name:LAURA
Middle Name:ANN
Last Name:GRAVES
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 DUGGAN CIR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01119-1906
Mailing Address - Country:US
Mailing Address - Phone:413-427-0444
Mailing Address - Fax:
Practice Address - Street 1:128 DUGGAN CIR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01119-1906
Practice Address - Country:US
Practice Address - Phone:413-427-0444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7841225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist