Healthcare Provider Details

I. General information

NPI: 1467981233
Provider Name (Legal Business Name): HAND CRAFTED THERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2017
Last Update Date: 07/25/2022
Certification Date: 07/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 N FIFTH AVE
SANDPOINT ID
83864-1520
US

IV. Provider business mailing address

PO BOX 822
SAGLE ID
83860-0822
US

V. Phone/Fax

Practice location:
  • Phone: 208-568-1983
  • Fax: 208-667-2119
Mailing address:
  • Phone: 208-568-1983
  • Fax: 208-568-1983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. LAUREN SUE GRAYBILL
Title or Position: OWNER
Credential: OTR/L, CLT
Phone: 208-568-1983