Provider Demographics
NPI:1235964818
Name:GRABER, STEPHANIE LAYNE (LMT)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LAYNE
Last Name:GRABER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5003
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97708-5003
Mailing Address - Country:US
Mailing Address - Phone:916-743-1196
Mailing Address - Fax:
Practice Address - Street 1:26 NW IRVING AVE
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-2012
Practice Address - Country:US
Practice Address - Phone:916-743-1196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27737225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist