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General NPI Number Information
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NPI Number | 1881383560
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Entity Type | Individual
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Provider Name | LUCIA GRADY OTR/L
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Gender | Female
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Dates
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Enumeration Date | 05/08/2023
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Last Update Date | 05/08/2023
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Provider Practice Location Address
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Address Line | 1445 E. PUTNAM AVENUE
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City | OLD GREENWICH
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State | CT
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Zip | 06870
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Country | US
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Telephone | 203-622-8600
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Fax |
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Provider Business Mailing Address
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Address Line | 321 STAMFORD AVENUE
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City | STAMFORD
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State | CT
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Zip | 06902
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Country | US
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Telephone | 203-981-5830
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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 | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 001194
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License Number State | CT
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