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General NPI Number Information
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NPI Number | 1518280882
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Entity Type | Individual
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Provider Name | REBECCA L. GRANTHAM O.T.
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Gender | Female
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Dates
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Enumeration Date | 03/01/2010
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Last Update Date | 01/14/2016
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Provider Practice Location Address
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Address Line | 1000 VETERAN AVE SUITE A-744
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City | LOS ANGELES
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State | CA
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Zip | 90095-8974
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Country | US
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Telephone | 323-794-1323
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Fax |
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Provider Business Mailing Address
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Address Line | 7712 LEXINGTON AVE
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City | WEST HOLLYWOOD
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State | CA
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Zip | 90046-6213
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Country | US
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Telephone | 601-317-1041
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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 | OT2334
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 11832
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License Number State | CA
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