Healthcare Provider Details

I. General information

NPI: 1831356823
Provider Name (Legal Business Name): DARLENE L GRIMES OT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2008
Last Update Date: 05/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 MORDINGTON AVENUE JEFFERSON COUNTY BOARD OF EDUCATION
CHARLES TOWN WV
25414
US

IV. Provider business mailing address

610 WV AVENUE
MARTINSBURG WV
25401
US

V. Phone/Fax

Practice location:
  • Phone: 304-725-9741
  • Fax:
Mailing address:
  • Phone: 304-267-3595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number992
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: