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NPI Code Detail

MEDICARE: JORDANN RYLEE GRAVES

MEDICARE: JORDANN RYLEE GRAVES
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 AssistantOTA008485OH

General Provider Information

NPI Number : 1518732072
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORDANN RYLEE GRAVES
Provider Business Mailing Address
First Line : 1211 S SANDUSKY AVE
Second Line :
City : BUCYRUS
State : OH
Zip : 44820-3249
Country : US
Telephone Number : 419-689-4796
Fax Number :
Provider Business Practice Location Address
First Line : 890 W 4TH ST
Second Line :
City : ONTARIO
State : OH
Zip : 44906-2565
Country : US
Telephone Number : 419-774-5520
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/15/2023
Last Update Date : 05/22/2026

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Directions to “ JORDANN RYLEE GRAVES ” Practice Location

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