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General NPI Number Information
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NPI Number | 1962798314
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Entity Type | Individual
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Provider Name | LARRY E GRAHAM JR.
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Gender | Male
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Dates
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Enumeration Date | 06/23/2011
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Last Update Date | 02/07/2019
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Provider Practice Location Address
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Address Line | 820 CAMELOT DR
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City | HARLINGEN
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State | TX
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Zip | 78550-8400
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Country | US
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Telephone | 956-423-2663
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Fax |
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Provider Business Mailing Address
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Address Line | 22 JEWELL GRAHAM RD
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City | PURVIS
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State | MS
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Zip | 39475-3266
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Country | US
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Telephone | 601-550-9959
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | OTA12262
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 211236
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License Number State | TX
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