=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508005133
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMANDA JOYCE GRIGGS OTR
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/04/2009
-----------------------------------------------------
Last Update Date | 02/04/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3424 FM 1092 RD SUITE 200
-----------------------------------------------------
City | MISSOURI CITY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77459-2285
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-403-5437
-----------------------------------------------------
Fax | 888-876-2741
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6140 HIGHWAY 6 # 90
-----------------------------------------------------
City | MISSOURI CITY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77459-3802
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-403-5437
-----------------------------------------------------
Fax | 888-876-2741
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225XP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Occupational Therapist
-----------------------------------------------------
License Number | 111028
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------