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NPI Code Detail

MEDICARE: JORDAN ALLEN GRANTZ COTA/L

MEDICARE: JORDAN ALLEN GRANTZ COTA/L
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
1224Z00000XOccupational Therapy Assistant0131001954VA

General Provider Information

NPI Number : 1295221109
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORDAN ALLEN GRANTZ COTA/L
Provider Business Mailing Address
First Line : 9421 EVERETTE CT
Second Line :
City : SPOTSYLVANIA
State : VA
Zip : 22553-1978
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2125 HILLIARD RD
Second Line :
City : RICHMOND
State : VA
Zip : 23228-4600
Country : US
Telephone Number : 804-266-9666
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/03/2018
Last Update Date : 07/03/2018

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Directions to “ JORDAN ALLEN GRANTZ COTA/L” Practice Location

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