MEDICARE: TALIA GRAGERT

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	16-0727	NV

General Provider Information

NPI Number	:	1558811448
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TALIA GRAGERT

Provider Business Mailing Address
First Line	:	4830 SILVER SAGE DR
Second Line	:
City	:	CARSON CITY
State	:	NV
Zip	:	89701-6659
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4830 SILVER SAGE DR
Second Line	:
City	:	CARSON CITY
State	:	NV
Zip	:	89701-6659
Country	:	US
Telephone Number	:	775-600-9491
Fax Number	:

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

Provider Enumeration Date	:	10/04/2016
Last Update Date	:	10/04/2016

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Directions to “ TALIA GRAGERT ” Practice Location

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