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NPI Code Detail

MEDICARE: BREANNE M GRASSO OTR/L

MEDICARE: BREANNE M GRASSO OTR/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
1225X00000XOccupational Therapist46TR00571700NJ
2225X00000XOccupational Therapist12749CA

General Provider Information

NPI Number : 1992078109
Entity Type Code : Individual
Provider Name (Legal Business Name) : BREANNE M GRASSO OTR/L
Provider Business Mailing Address
First Line : 2500 COUNTRY DR
Second Line :
City : FREMONT
State : CA
Zip : 94536-5356
Country : US
Telephone Number : 201-317-1056
Fax Number :
Provider Business Practice Location Address
First Line : 2500 COUNTRY DR
Second Line :
City : FREMONT
State : CA
Zip : 94536-5356
Country : US
Telephone Number : 201-317-1056
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/18/2012
Last Update Date : 01/23/2015

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Directions to “ BREANNE M GRASSO OTR/L” Practice Location

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