Individual
LAUREN E GRAVELINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
7505 COUNTRY CLUB DR, GOLDEN VALLEY, MN 55427-4501
(763) 450-6902
Mailing address
7505 COUNTRY CLUB DR, GOLDEN VALLEY, MN 55427-4501
(763) 450-6902
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
201924
MN
246Z00000X
Other Specialist/Technologist
Primary
201924
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
201924
STATE OF MINNESOTA
MN
Enumeration date
05/05/2014
Last updated
05/05/2014
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