=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578324422
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAUREN NICOLE GRAGG OTD, OTR
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/18/2024
-----------------------------------------------------
Last Update Date | 01/18/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6001 FANNIN ST
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77030
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-693-0628
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6506 CRESTRIDGE ST
-----------------------------------------------------
City | MANVEL
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77578-4016
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-693-0628
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 124287
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------