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General NPI Number Information
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NPI Number | 1245804012
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Entity Type | Individual
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Provider Name | GRACE KATHRYN LAURENT MS
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Gender | Female
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Dates
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Enumeration Date | 05/17/2021
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Last Update Date | 05/17/2021
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Provider Practice Location Address
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Address Line | 3333 UNIVERSITY AVE SE
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City | MINNEAPOLIS
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State | MN
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Zip | 55414-3325
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Country | US
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Telephone | 612-331-9413
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Fax |
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Provider Business Mailing Address
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Address Line | 1345 KENT ST
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City | SAINT PAUL
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State | MN
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Zip | 55117-4225
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Country | US
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Telephone | 952-465-1608
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 106485
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License Number State | MN
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