Healthcare Provider Details

I. General information

NPI: 1790903789
Provider Name (Legal Business Name): LAUREN SUE GRAYBILL OTR/L, CLT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAUREN SUE SCHOLAR OTR/L, CLT

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 S 2ND AVE
WALLA WALLA WA
99362-4116
US

IV. Provider business mailing address

1025 S 2ND AVE
WALLA WALLA WA
99362-4116
US

V. Phone/Fax

Practice location:
  • Phone: 509-897-2100
  • Fax: 509-897-5752
Mailing address:
  • Phone: 509-897-2100
  • Fax: 509-897-5752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT60629684
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: