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General NPI Number Information
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NPI Number | 1770849226
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Entity Type | Individual
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Provider Name | GRACE LYNNETTE BEAL OTR
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Gender | Female
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Dates
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Enumeration Date | 04/10/2012
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Last Update Date | 04/10/2012
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Provider Practice Location Address
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Address Line | 23110 FORD RD STE A
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City | PORTER
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State | TX
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Zip | 77365-5416
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Country | US
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Telephone | 281-354-3383
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Fax | 281-354-6750
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Provider Business Mailing Address
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Address Line | PO BOX 9
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City | PORTER
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State | TX
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Zip | 77365-0009
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Country | US
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Telephone | 281-354-3383
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Fax | 281-354-6750
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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 | 114653
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License Number State | TX
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