MEDICARE: MRS. GRESHUNDRIA MANIK RAINES OTR

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	1848	AL

General Provider Information

NPI Number	:	1487608956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GRESHUNDRIA MANIK RAINES OTR

Provider Business Mailing Address
First Line	:	PO BOX 240243
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36124-0243
Country	:	US
Telephone Number	:	334-514-4953
Fax Number	:

Provider Business Practice Location Address
First Line	:	915 S JACKSON ST
Second Line	:	ASU, DEPARTMENT OF OCCUPATIONAL THERAPY
City	:	MONTGOMERY
State	:	AL
Zip	:	36104-5732
Country	:	US
Telephone Number	:	334-229-5602
Fax Number	:

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

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	07/16/2007

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