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NPI Code Detail

MEDICARE: AMBER GRAVES OTRL

MEDICARE: AMBER GRAVES OTRL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist5201008368MI

General Provider Information

NPI Number : 1174025852
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMBER GRAVES OTRL
Provider Business Mailing Address
First Line : 5410 TALL OAKS DR
Second Line :
City : FLINT
State : MI
Zip : 48507-3675
Country : US
Telephone Number : 810-624-2345
Fax Number :
Provider Business Practice Location Address
First Line : 2304 W FRANCES RD
Second Line :
City : MOUNT MORRIS
State : MI
Zip : 48458-8229
Country : US
Telephone Number : 810-564-3160
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/08/2018
Last Update Date : 03/08/2018

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