Provider Demographics
NPI:1194732818
Name:HARRALL, LAUREN (ATC)
Entity type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:
Last Name:HARRALL
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:MS
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:GOLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:3 KEANEY ROAD
Mailing Address - Street 2:SUITE ONE
Mailing Address - City:KINGSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02881
Mailing Address - Country:US
Mailing Address - Phone:401-874-2051
Mailing Address - Fax:401-874-4804
Practice Address - Street 1:3 KEANEY ROAD
Practice Address - Street 2:SUITE ONE
Practice Address - City:KINGSTON
Practice Address - State:RI
Practice Address - Zip Code:02881
Practice Address - Country:US
Practice Address - Phone:401-874-2051
Practice Address - Fax:401-874-4804
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2018-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAT002322255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer