MEDICARE: KAILA GRAHAM OTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	26933	CA

General Provider Information

NPI Number	:	1205658192
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAILA GRAHAM OTD

Provider Business Mailing Address
First Line	:	PO BOX 5487
Second Line	:
City	:	HERCULES
State	:	CA
Zip	:	94547-5487
Country	:	US
Telephone Number	:	510-484-3394
Fax Number	:

Provider Business Practice Location Address
First Line	:	2770 PLEASANT HILL RD
Second Line	:
City	:	PLEASANT HILL
State	:	CA
Zip	:	94523-2044
Country	:	US
Telephone Number	:	925-900-3393
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/30/2024
Last Update Date	:	10/30/2024

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