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General NPI Number Information
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NPI Number | 1225539604
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Entity Type | Organization
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Legal Business Name | GRAND THERAPY LLC
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Dates
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Enumeration Date | 02/22/2018
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Last Update Date | 05/28/2020
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Provider Practice Location Address
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Address Line | 3701 DURLEY LN # ME
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City | GWYNN OAK
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State | MD
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Zip | 21207-3855
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Country | US
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Telephone | 757-803-8731
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Fax |
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Provider Business Mailing Address
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Address Line | 3701 DURLEY LN
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City | GWYNN OAK
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State | MD
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Zip | 21207-3855
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Country | US
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Telephone | 757-803-8731
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Fax |
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Authorized Official
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Title or Position | OWNER/OCCUPATIONAL THERAPIST
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Name | KIMBERLY SHARRI TOWNSEND
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Credential | M.S., OTR/L
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Telephone | 757-803-8731
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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 | 07253
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License Number State | MD
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