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General NPI Number Information
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NPI Number | 1114589272
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Entity Type | Individual
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Provider Name | JANIE GRANT OT
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Gender | Female
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Dates
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Enumeration Date | 06/28/2019
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Last Update Date | 06/28/2019
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Provider Practice Location Address
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Address Line | 500 TAMAL PLZ STE 525&527
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City | CORTE MADERA
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State | CA
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Zip | 94925-1151
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Country | US
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Telephone | 415-531-3027
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Fax | 941-655-8839
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Provider Business Mailing Address
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Address Line | 301 NORTH AVE UNIT 102
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City | SAN RAFAEL
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State | CA
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Zip | 94903-5557
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Country | US
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Telephone | 818-640-3359
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 19097
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License Number State | CA
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