MEDICARE: MR. CHRISTOPER MICHAEL GRANT OTR

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
1	225X00000X	Occupational Therapist	0172241	NY

General Provider Information

NPI Number	:	1366676215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHRISTOPER MICHAEL GRANT OTR

Provider Business Mailing Address
First Line	:	112 SKI BOWL RD
Second Line	:
City	:	NORTH CREEK
State	:	NY
Zip	:	12853-2607
Country	:	US
Telephone Number	:	518-251-2447
Fax Number	:

Provider Business Practice Location Address
First Line	:	112 SKI BOWL RD
Second Line	:
City	:	NORTH CREEK
State	:	NY
Zip	:	12853-2607
Country	:	US
Telephone Number	:	518-251-2447
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/06/2009
Last Update Date	:	01/09/2015

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