Healthcare Provider Details

I. General information

NPI: 1215374137
Provider Name (Legal Business Name): MICHAEL ALEXANDER LAGRAFF OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2013
Last Update Date: 06/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9051 EXECUTIVE PARK DR SUITE 600
KNOXVILLE TN
37923-4606
US

IV. Provider business mailing address

9051 EXECUTIVE PARK DR SUITE 600
KNOXVILLE TN
37923-4606
US

V. Phone/Fax

Practice location:
  • Phone: 865-200-5127
  • Fax:
Mailing address:
  • Phone: 865-200-5127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number4734
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: